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Acute pulmonary oedema: not always cardiogenic
M Bonello1, R Pullicino, A J Larner
1M Bonello, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
Summary
Fulminant pulmonary oedema can be caused by neurogenic factors, not just cardiac issues. This case highlights vertebral artery dissection leading to brainstem dysfunction and subsequent pulmonary oedema.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Pulmonary oedema typically suggests cardiac dysfunction.
- Acute respiratory distress necessitates immediate intervention, including intubation and ventilation.
Observation:
- A patient presented with severe pulmonary oedema without a history of cardiac disease.
- Neurological signs of brainstem dysfunction emerged during the weaning from sedation.
Findings:
- Investigations revealed posterior cerebral circulation infarcts.
- The infarcts were attributed to a vertebral artery dissection.
Implications:
- Neurogenic pulmonary oedema should be considered in acute pulmonary oedema cases without cardiac etiology.
- Vertebral artery dissection can manifest with severe neurological and respiratory compromise.
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