[Neurogenic pulmonary edema]

In a patient, admitted for cerebral stroke with right side hemiparesis, an acute episode of dyspnea has developed 6 hours after admission. Based on a finding of fine rales on auscultation and a chest radiogram showing congestion, a diagnosis of pulmonary edema was made. The electrocardiogram and cardiac enzymes were normal. Other routine precipitating factors were excluded, and the acute left heart failure was ascribed to the patient's stroke. Neurogenic pulmonary edema may be a result of a vast range of neurological lesions or conditions, including status epilepticus, head trauma, subdural and subarachnoid hemorrhage, brain tumors, meningitis, multiple sclerosis and ischemic stroke. This condition is probably mediated by the sympathetic system outflow, leading eventually to an increase of left atrial pressure, or to an increase in pulmonary vessel permeability. It is treated conventionally, with diuretics and after-load reduction.