title: Neurogenic pulmonary oedema complicating traumatic posterior fossa extradural haematoma: Case report and review.
abstract: Pulmonary oedema is accumulation of fluid in the lung air spaces and interstitia. Neurogenic pulmonary oedema (NPE) is a potentially life-threatening condition which has been noted in head injury, subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and others. Timely management is crucial to achieve good outcome; however, no specific guidelines have been defined.
  
  
  
  A 33-year female involved in a motor vehicular accident had a GCS of 14/15 and CT scan showed a moderate-sized unilateral posterior fossa extradural haematoma (PFEDH). She had sudden deterioration in her haemodynamic status with drop in sensorium 2 hours after admission. There was a copious amount of frothy secretions noted on intubation and she was diagnosed as having NPE.
  
  
  
  Sub-occiptial craneictomy (SOC) with haematoma evacuation was performed and was managed with PEEP mechanical ventilation post-operatively. Excellent outcome was obtained and was discharged with a GOS of 5.
  
  
  
  NPE is a poorly understood and uncommon complication of acute CNS injury and should be considered in any patient with acute respiratory distress in the setting of CNS injury. Reduction in ICP and supportive mechanical ventilation form the mainstay of management. Diagnosis of NPE remains challenging and more reliable diagnostic criteria need to be defined to identify such cases with greater frequency.
authors.affiliation: a Department of Neurosurgery.
authors.forename: Ajay
authors.initials: A
authors.lastname: Hegde
authors.affiliation: a Department of Neurosurgery.
authors.forename: G Lakshmi
authors.initials: GL
authors.lastname: Prasad
authors.affiliation: b Department of Anesthesia, Kasturba Medical College , Manipal University , Manipal , India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Kini
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
keywords: Neurogenic pulmonary oedema; catecholamine surge; mechanical ventilation; pathophysiology; posterior fossa extradural haematoma; review