Neurogenic Pulmonary Oedema

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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 α‐ or β‐adrenergic discharge. NPE results from a predominant α‐receptor stimulation with massive increase in pre‐ and after load. 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.