QUICK PEARLS:
WHAT IS IT?
increase in pulmonary interstitial & alveolar fluid, developing rapidly after acute CNS injury (e.g. seizure, trauma, cerebral hemorrhage)
shares characteristics of ARDS (acute respiratory distress syndrome)
SYMPTOMS/FINDINGS include:
- dyspnea
- mild hemoptysis (maybe)
- tachypnea
- tachycardia
- basilar rales/pulmonary edema
- normal heart size
PATHOPHYS?
“remains incompletely understood” (awesome)
usually associated with elevated ICP, but elevated ICP is not necessary to have neurogenic pulm edema
theories include:
- medulla oblongata mediated – sympathetic surge
- pulmonary venoconstriction
- increased pulm capillary permeability, by secondary mediators (e.g. histamine, bradykinin) or microvascular injury from high pressure surge
,
INTERESTING TIDBITS:
- alpha adrenergic blockage (e.g. phentolamine) can prevent NPE (animal models). so can spinal cord transection at/above C7, & denervation of sympathetic fibers to lungs.
TREATMENT:
supportive care (ABC’s)
treat the underlying disorder
majority resolve in 2-3 days
data for meds (e.g. phentolamine) is limited, and NPE should resolve anyways, so hard to read into results — proceed with caution
supportive care (ABC’s)
References: uptodate.com: neurogenic pulmonary edema; picture
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