Neurogenic Pulmonary Edema

Excerpt

By definition, neurogenic pulmonary edema (NPE) is a clinical condition characterized by the acute accumulation of extravascular pulmonary fluid following a severe central nervous system (CNS) insult, most commonly involving the brainstem, and typically manifests as acute respiratory distress. W. T. Shanahan was the first to describe acute NPE in 1908. Francois Moutier notably described the sudden onset of pulmonary edema among soldiers who sustained headshot wounds during World War I.

NPE requires the exclusion of other identifiable pulmonary lesions or sources of cardiovascular impairment that may accompany nervous system compromise, eg, pulmonary aspiration or other ischemic, toxic, or traumatic lesions of the heart or lungs, even though these conditions may coexist with pulmonary edema.

If the clinical presentation is unequivocal, the diagnosis should be presumed when acute pulmonary edema is associated with CNS injury in the absence of primary pulmonary or cardiovascular damage. However, some ambiguity may still persist, particularly because the exact pathogenesis of NPE is not fully understood, as described in the literature. One of the main proposed mechanisms is sympathetic storm/catecholamine-mediated pulmonary vasoconstriction.