Background
Neurogenic pulmonary edema (NPE) is a relatively rare form of pulmonary edema caused by an increase in pulmonary interstitial and alveolar fluid. Any acute central nervous system (CNS) insult can result in pulmonary edema. The most common causes are subarachnoid hemorrhage,
cerebral hemorrhage,
traumatic brain injury (TBI),
and seizures.
Neurogenic pulmonary edema most commonly develops within a few hours after a neurologic insult, and is characterized by dyspnea, bilateral basal pulmonary crackles, and the absence of cardiac failure.
However, a delayed form of NPE that develops 12 to 24 hours after the CNS insult has been reported.
Symptoms often spontaneously resolve within 24 to 48 hours; however, in patients with ongoing brain injury and elevated intracranial pressure (ICP), the NPE often persists.
No specific laboratory study confirms the diagnosis of neurogenic pulmonary edema (NPE). NPE is a diagnosis of exclusion,
and diagnosis requires exclusion of other causes of pulmonary edema (eg, high-altitude pulmonary edema).
The management of NPE is focused on treating the underlying neurologic condition. Treatment efforts to reduce ICP, including decompression and clot evacuation, osmotic diuretics, anti-epileptics, tumor resection, and steroids have all been associated with improvements in oxygenation.
For patient education resources, see the Brain and Nervous System Center and Stroke.