Neurogenic Pulmonary Edema

Epidemiology

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Etiology

  • Air Embolism (see Air Embolism, [[Air Embolism]])
  • Brain Tumor
  • Bulbar Polimyelitis (see Polimyelitis, [[Polimyelitis]])
  • Cervical Spine Injury: uncommon etiology
  • Electroconvulsive Therapy (ECT)
  • Encephalitis (see Encephalitis, [[Encephalitis]]): uncommon etiology
  • Head Trauma: common etiology (occurs in >50% of cases)
  • Increased Intracranial Pressure (of any etiology)
  • Intracerebral Hemorrhage (ICH) (see Intracerebral Hemorrhage, [[Intracerebral Hemorrhage]])
    • Neurogenic pulmonary edema may recur after initial resolution
  • Intracranial Endovascular Therapy
  • Intracranial Tumor
  • Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]]): uncommon etiology of neurogenic pulmonary edema
  • Meningitis (see Meningitis, [[Meningitis]])
  • Multiple Sclerosis with Medullary Involvement (see Multiple Sclerosis, [[Multiple Sclerosis]]): uncommon etiology
  • Seizures (see Seizures, [[Seizures]]): occurs in up to 33% of patients with grand mal seizures
  • Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage, [[Subarachnoid Hemorrhage]]): common etiology (occurs in up to 71% of fatal cases)
    • Neurogenic pulmonary edema may recur after initial resolution
    • Risk Factors: increased age and higher clinical grade of subarachnoid hemorrhage

Physiology

Mechanism of Neurogenic Pulmonary Edema in Subarachnoid Hemorrhage

  • Increased Intracranial Pressure, Resulting in Sympathetic Activation
    • Pulmonary Vasoconstriction -> Increased Pulmonary Venous Pressure -> Increased Pulmonary Capillary Pressure -> Increased Pulmonary Capillary Permeability
    • Systemic Vasoconstriction
      • Shift of Blood from Systemic to Pulmonary Circulation -> Increased Pulmonary Blood Volume
      • Increased Systemic Blood Pressure -> Decreased Left Ventricular Compliance -> Increased Left Atrial Pressure (Increased PCWP) -> Increased Pulmonary Capillary Pressure -> Increased Pulmonary Capillary Permeability

Clinical Manifestations

Pulmonary Manifestations

  • Pulmonary Edema (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
    • Neurogenic pulmonary edema may recur in some cases of subarachnoid or intracranial hemorrhage after initial resolution

Treatment

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References

  • Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. Jun 1995;23(6):1007-17
  • Neurogenic pulmonary edema. Acta Anaesthesiol Scand. Apr 2007;51(4):447-55
  • Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. J Neurosurg Anesthesiol. Jul 2008;20(3):188-92
  • Mechanisms of neurogenic pulmonary edema development. Physiol Res. 2008;57(4):499-506
  • Cardiac troponin I and acute lung injury after subarachnoid hemorrhage. Neurocrit Care. 2009;11(2):177-82
  • Neurogenic pulmonary edema associated with pediatric status epilepticus. Pediatr Emerg Care. Oct 2011;27(10):957-8
  • Neurogenic pulmonary edema in subarachnoid hemorrage. Panminerva Med. Sep 2011;53(3):203-10