EMmedonline

• Neurogenic pulmonary edema is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system insult like spinal cord injury, subarchanoid hemorrhage (SAH), traumatic brain injury, intracranial hemorrhage, status epilepticus, meningitis and subdural hemorrhage in conditions that cause abrupt, rapid and extreme elevation in ICP.

   

• The etiology is thought to be a surge of catecholamines that results in cardiopulmonary dysfunction especially in patient with abrupt, rapid and extreme elevation in ICP.

• Some studies states that abrupt increase in systemic and pulmonary pressures following catecholamines surge results in shift of blood from systemic circulation to pulmonary circulation leading to increase in pulmonary pressure. The increased pulmonary pressure leads to damage of capillary alveolar membrane. This leads to pulmonary edema.

Clinical Characteristics

• Two distinct clinical forms of NPE are present

  • Early NPE is most common and characterised by the development of symptoms within minutes to hrs following neurologic injury.

  • Delayed form develop 12 – 24 hrs after CNS insult.

     

• Patient can become acutely tachypneic, hypoxia.

• Pink frothy sputum is commonly seen

• Bilateral crackles and rales

• Tachyardia, hypertension

• Leukocytosis

• Xray : Hyperdense infiltrates consistent with ARDS

Diagnosis

• It is usually by exclusion of other causes.

• Differential diagnosis includes aspiration pneumonia, ARDS, cardiogenic pulmonary edema

Management

• Treat the underlying etiology.

• Appropriate management of airway and breathing like NIV, early intubation to considered.

• Efforts to reduce the ICP including decompression, & clot evacuation, osmotic diuretics, antiepileptics, tumor resection and steroids all have been associated with improvements in oxygenation.

Updated on 26/4/14

Reference

• Neurogenic pulmonary edema ; By Daniella L davison ; Annual Update in Intensive Care and Emergency medicine 2012.