title: Neurogenic pulmonary oedema. A review of the pathophysiology with clinical and therapeutic implications.
abstract: Five cases of neurogenic pulmonary oedema (NPE) are described. The causes were mechanical trauma to the skull, subarachnoid haemorrhage and epileptic seizure. In every case a frank pulmonary oedema was diagnosed that resolved within a few days. Treatment of the underlying disease resulted in a favourable outcome. The literature has been reviewed. The basic mechanism seems to be an increased intracranial pressure (ICP) precipitating an increased central sympathetic nerve activity mediated via peripheral alpha- or beta-adrenergic discharge. NPE results from a predominant alpha-receptor stimulation with massive increase in pre- and afterload. The major therapeutic efforts should be directed towards the underlying cause and, in addition, mechanical ventilation with passive hyperventilation is vital. High positive end-expiratory pressure should not be used without strict monitoring of ICP.
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000150:complications* / Q000503:physiopathology; D004827:Epilepsy / Q000150:complications; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D012886:Skull / Q000293:injuries; D013345:Subarachnoid Hemorrhage / Q000150:complications