Neurogenic pulmonary edema associated with autonomic dysreflexia

Neurogenic pulmonary edema is associated with a variety of central nervous system injuries and results from a massive centrally mediated sympathetic discharge. Another syndrome characterized by sympathetic overactivity is autonomic dysreflexia, which occurs in patients with spinal cord injury above T4 to T6. We describe a patient with a cervical spinal cord injury who had intense, prolonged autonomic dysreflexia following external sphincterotomy, which culminated in pulmonary edema. Traction on an over-inflated Foley catheter balloon was the stimulus for autonomic dysreflexia and deflation of the balloon resulted in prompt resolution of autonomic dysreflexia and pulmonary edema. The pathophysiology of neurogenic pulmonary edema and autonomic dysreflexia is discussed.