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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
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.
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor