Neurogenic pulmonary oedema complicating a lateral medullary infarct

Abstract

Neurogenic pulmonary oedema (NPO) is a rare clinical syndrome of pulmonary oedema occurring secondary to an insult of the central nervous system (CNS). The exact aetiology of this disorder is unknown. NPO can be fatal and poor awareness and identification of this entity, particularly in terms of misdiagnosis as primary pulmonary or cardiac disease, can result in suboptimal management and outcomes. We describe the presentation and management of a 68-year-old woman with an acute left lateral medullary stroke complicated by pulmonary oedema. The likely aetiology is discussed, and important learning points are highlighted.

Keywords: brain stem / cerebellum; heart failure; neuroimaging; neurology; stroke.

Figure 1

CT angiogram demonstrating occlusion of the left vertebral artery.

Figure 2

(A) Anterior-posterior (AP) portable chest X-ray demonstrating bilateral interstitial oedema and blunting of the right costophrenic angle. (B) AP chest X-ray demonstrating resolution of interstitial oedema, although blunting of left costophrenic angle now evident.

Figure 3

MRI demonstrating an infarct in the left posterior lateral aspect of the medulla (left: coronal fluid attenuation inversion recovery sequence; middle: axial diffusion weighted imaging; right: accompanying apparent diffusion coefficient image).