Acute Neurogenic Pulmonary Edema: The Unaddressed Mechanism of Death
DOI:
https://doi.org/10.48165/Keywords:
Neurogenic pulmonary edema, Head injury, Haemorrhage, Sudden deathAbstract
Impaired pulmonary function is a frequent but poorly understood complication of acute head injury. A potential early contributor to the pulmonary dysfunction seen in Head injury patients is neurogenic pulmonary edema (NPE). Neurogenic Pulmonary Edema is pulmonary edema that is associated with neurological diseases in patients in whom no other cardiac or pulmonary cause for the edema is apparent. It is associated with several acute neurological catastrophes; including spontaneous intracranial haemorrhage in general and Sub-arachnoid haemorrhage secondary to aneurysmal rupture in particular, sudden unexpected death in epilepsy, and traumatic brain injuries of various types. Often, very less described in the literature, this can be an immediate cause of death in patients with head injuries. Its pathophysiology is multifactorial but largely unknown. It‘s not only for the clinician to be aware of this clinical entity but it‘s also important for the Forensic Medicine expert to know about the pathophysiology, clinical presentation and autopsy findings of NPE. This paper aims to review the current concepts on pathophysiologic mechanisms involved in the development of NPE and discuss the facts which are relevant for a Forensic expert.
Downloads
References
Rogers FB, Shackford SR, Trevisani GT, Davis JW, Mackersie RC, Hoyt DB. Neurogenic pulmonary edema in fatal and nonfatal head injuries. The J of trauma. 1995;39(5):860-6; discussion 6-8.
Bratton SL, Davis RL. Acute lung injury in isolated traumatic brain injury. Neurosurgery. 1997;40(4):707-12.
Muroi C, Keller M, Pangalu A, Fortunati M, Yonekawa Y, Keller E. Neurogenic pulmonary edema in patients with subarachnoid hemorrhage. J of neurosurgical anesthesiology. 2008;20(3):188-92.
Young Y-R, Lee C-C, Sheu B-F, Chang S-S. Neurogenic cardiopulmonary complications associated with spontaneous cerebellar hemorrhage. Neurocritical care. 2007;7(3):238-40.
Wąsowska-Królikowska K, Krogulska A, Modzelewska Hołyńska M. Neurogenic pulmonary oedema in a 13-year-old boy in the course of symptomatic epilepsy–case report. Med Sci Monit. 2000;6(5):1003-7.
Aslam AF, Aslam AK, Vasavada BC, Khan IA. Cardiac effects of acute myelitis. International journal of cardiology. 2006;111(1):166- 8.
Tsutsumi N, Tohdoh Y, Kawana S, Kozuka Y, Namiki A. A case of pulmonary edema after electroconvulsive therapy under propofol anesthesia. Masui The Japanese journal of anesthesiology. 2001;50(5):525-7.
Nelson AM, McMorrow ME. Neurogenic Pulmonary Edema: A common complication of central nervous system injury. AJN The American Journal of Nursing. 2002;102:44-8.
Watanabe M, Higashimoto I, Niina K, Kawabata M, Osame M. An autopsy case of neurogenic pulmonary edema due to suicide by hanging. Nihon Kokyuki Gakkai zasshi= the journal of the Japanese Respiratory Society. 2000;38(10):797-800.
Inobe J-i, Mori T, Ueyama H, Kumamoto T, Tsuda T. Neurogenic pulmonary edema induced by primary medullary hemorrhage: a case report. Journal of the neurological sciences. 2000;172(1):73-6.
Cushing H. I. On the Avoidance of Shock in Major Amputations by Cocainization of Large Nerve-Trunks Preliminary to their Division. With Observations on Blood-Pressure Changes in Surgical Cases. Annals of Surgery. 1902;36(3):321-45.
Simmons RL, Heisterkamp CA, Collins JA, Genslar S, Martin AM. Respiratory insufficiency in combat casualties. 3. Arterial hypoxemia after wounding. Annals of Surgery. 1969;170(1):45-52.
Antoniuk SA, Oliva LV, Bruck I, Malucelli M, Yabumoto S, Castellano JL. Sudden unexpected, unexplained death in epilepsy autopsied patients. Arquivos de neuro-psiquiatria. 2001;59(1):40-5.
Fontes RB, 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(2):144-50.
Friedman JA, Pichelmann MA, Piepgras DG, McIver JI, Toussaint LG, 3rd, McClelland RL, et al. Pulmonary complications of aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003;52(5):1025-31; discussion 31-2.
Solenski NJ, Haley EC, Jr., Kassell NF, Kongable G, Germanson T, Truskowski L, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Critical care medicine. 1995;23(6):1007-17.
Kosnik EJ, Paul SE, Rossel CW, Sayers MP. Central neurogenic pulmonary edema: with a review of its pathogenesis and treatment. Child's brain. 1977;3(1):37-47.
Lee K, Rincon F. Pulmonary complications in patients with severe brain injury. Critical care research and practice. 2012;2012:207247. 19. Mackersie RC, Christensen JM, Pitts LH, Lewis FR. Pulmonary extravascular fluid accumulation following intracranial injury. The Journal of trauma. 1983;23(11):968-75.