Acute Neurogenic Pulmonary Edema: The Unaddressed Mechanism of Death

Abstract

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.