Hyper-acute neurogenic pulmonary oedema in a prehospital setting: a case report
1Community Health Centre Vrhnika, 1360 Vrhnika, Slovenia
2Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
3Department of Neurology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
DOI: 10.22514/sv.2021.087 Vol.17,Issue 4,July 2021 pp.208-211
Submitted: 13 October 2020 Accepted: 09 March 2021
Published: 08 July 2021
Introduction: Neurogenic pulmonary oedema (NPO) is a form of pulmonary oedema which can develop after an acute central nervous system (CNS) lesion, most often a subarachnoid haemorrhage (SAH). Its pathogenesis is associated with a surge of catecholamines which are released into the systemic circulation following an abrupt increase in intracranial pressure or a strategic CNS lesion. NPO typically presents with dyspnoea, tachypnoea, hypoxia, pink frothy sputum, bilateral crackles on auscultation, and bilateral infiltrates on chest X-ray in a few hours or days following the event.
Case report: The following case report describes a case of hyper-acute NPO following a SAH, which presented as acute respiratory failure in the minutes after the event and required fast and aggressive treatment in the prehospital setting.
Conclusion: The management of NPO is primarily focused on prompt diagnosis and treatment of a CNS event and supportive care.
Pulmonary oedema; Prehospital emergency care; Neurology
Lucija Galič,Andrej Fabjan,Vesna Homar. Hyper-acute neurogenic pulmonary oedema in a prehospital setting: a case report. Signa Vitae. 2021. 17(4);208-211.
 Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiologica Scandinavica. 2007; 51: 447–455.
 Junttila E, Ala-Kokko T, Ohtonen P, Vaarala A, Karttunen A, Vuolteenaho O, et al. Neurogenic pulmonary edema in patients with nontraumatic intracerebral hemorrhage: predictors and association with outcome. Anesthesia & Analgesia. 2013; 116: 855–861.
 Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Critical Care. 2012; 16: 212.
 Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Archives of Neurology. 2000; 57: 1685–1688.
 Raja HM, Herwadkar AV, Paroutoglou K, Lilleker JB. Neurogenic pulmonary oedema complicating a lateral medullary infarct. BMJ Case Reports. 2018; 2018: bcr2018225437.
 Bruder N, Rabinstein A. Cardiovascular and pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurocritical Care. 2011; 15: 257–269.
 Macmillan CSA, Grant IS, Andrews PJD. Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management?Intensive Care Medicine. 2002; 28: 1012–1023.
 Chen P, Chen LS, Fishbein MC, Lin S, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circulation Research. 2014; 114: 1500–1515.
 Fontes RBV, Aguiar PH, Zanetti MV, Andrade F, Mandel M, Teixeira MJ. Acute neurogenic pulmonary edema: case reports and literature review. Journal of Neurosurgical Anesthesiology. 2003; 15: 144–150.
 Muroi C, Keller M, Pangalu A, Fortunati M, Yonekawa Y, Keller E. Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. Journal of Neurosurgical Anesthesiology. 2008; 20: 188–192.
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