Neurogenic pulmonary oedema in man: aetiology and management with vasodilators based on haemodynamic studies

Acute pulmonary oedema is a rare complication of head injury. A case is reported in which the pulmonary oedema was treated initially by tracheal intubation, constant positive airway pressure, ventilation and isoprenaline. Subsequent treatment was by vasodilation with sodium nitroprusside and phenoxybenzamine and the patient made a good recovery. The findings are discussed in relation to reported experimental work. The aetiology appears to be related to a massive sympathetic discharge leading to systemic vasoconstriction, shift of blood to the pulmonary circulation with left ventricular failure and pulmonary oedema.