Neurogenic pulmonary edema
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The diagnosis of neurogenic pulmonary edema is based on the occurrence of edema after a neurologic event/insult and the exclusion of other plausible causes.
The incidence of neurogenic pulmonary edema is difficult to estimate, with the majority of published studies regarding this entity being case report level data. Noted associations include:
- particularly with enterovirus-71
- marked variability in reported incidence, ranging from 7% to 78% in fatal cases secondary to aneurysmal rupture 5,8
- traumatic brain injury
Two distinct syndromes have been described based on the time course elapsed from the inciting event, both presenting with signs and symptoms of respiratory distress (e.g. dyspnea, tachypnea, crackles) with subsequent progression to hypoxemic respiratory failure;
- "early" or "acute" neurogenic pulmonary edema (most common)
- occurs within the first 4 hours in the majority (71.4%) of patients 9
- association with younger patients and higher serum glucose 6
- spontaneous resolution within 48–72 hours 5
- "delayed" neurogenic pulmonary edema
- onset within 12-24 hours
- similar time course
It characteristically presents within minutes to hours following a neurologic insult and usually resolves within 72 hours.
The exact pathophysiology is unclear but is thought to be the result of an adrenergic response leading to increased pulmonary hydrostatic pressure and increased lung capillary permeability 2.
On chest radiographs, there are nonspecific, bilateral, rather homogeneous airspace consolidative appearances with an apical predominance is thought to the present in about half of cases 4.
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- 2. Tan CK, Lai CC. Neurogenic pulmonary edema. CMAJ. 2007;177 (3): 249-50. doi:10.1503/cmaj.061584 - Free text at pubmed - Pubmed citation
- 3. Mcmanis P, Lee C, Morgan M et-al. Neurogenic pulmonary oedema. Aust N Z J Med. 2000;30 (4): 514. - Pubmed citation
- 4. Gluecker T, Capasso P, Schnyder P et-al. Clinical and radiologic features of pulmonary edema. Radiographics. 19 (6): 1507-31. Radiographics (citation) - Pubmed citation
- 5. Finsterer J, Finsterer. Neurological Perspectives of Neurogenic Pulmonary Edema. (2020) European neurology. doi:10.1159/000500139 - Pubmed
- 6. Liu H, Liu SQ, Liu ZX, Liu GY, Liu YY, Liu ZQ, Liu. Identification and Treatment of the Early Form of Neurogenic Pulmonary Edema in Emergency Room. (2015) Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae. doi:10.3881/j.issn.1000-503X.2015.03.019 - Pubmed
- 7. Danielle L Davison, Megan Terek, Lakhmir S Chawla. Neurogenic pulmonary edema. (2012) Critical Care. 16 (2): 1. doi:10.1186/cc11226
- 8. Amit Agrawal, Jake Timothy, Lekha Pandit, Anand Kumar, Gautam Kumar Singh, Ramasubramanian Lakshmi. NEUROGENIC PULMONARY OEDEMA. (2020) undefined.
- 9. Fontes RB, Aguiar PH, Zanetti MV, Andrade F, Mandel M, Teixeira MJ. Acute neurogenic pulmonary edema: case reports and literature review. (2003) Journal of neurosurgical anesthesiology. 15 (2): 144-50. doi:10.1097/00008506-200304000-00013 - Pubmed