Abstract
Background:Neurogenic pulmonary edema is a less recognized complication of head injuries and is seldom considered in management protocols in most centers. We therefore conducted a study to determine the prevalence of Neurogenic Pulmonary Edema among patients who died from head injury at Mulago National Referral Hospital, Uganda.Methods:An observational study conducted from the 1stJune to 31stAugust 2013, with ethical approval. We consecutively enrolled patients who died of head injuries in the hospital. Demographic data, duration of illness, severity of illness, and patient management instituted were gathered from patient medical files. Autopsy results of the brain, lungs, heart, liver and kidneys performed within 24 hours after death were reviewed.Results:Twenty-six patients who died from head injury were enrolled in this study over the study period. Only one patient had preexisting hypertension and obesity while the rest had no known premorbid medical history. Intracranial abnormalities including raised intracranial pressure had been detected by CT scan in 18/26 of the patients while others had a normal scan (1/26) or did not have a scan done (7/26). Features of pulmonary edema were detected in 76.9% (20/26) of the bodies on gross lung examination. Pulmonary edema was bilateral in 85% of the bodies. Congestion was also noted in the liver, heart and kidneys.Conclusions:Pulmonary edema is highly prevalent in head injury patients and needs to be critically recognized early in the formulation of a management plan, as it contributes to morbidity and secondary brain injury through respiratory embarrassment.
Highlights
Neurogenic pulmonary edema (NPE) is an age-old clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system (CNS) insult[1]
This was followed by reports of cases in which acute pulmonary edema developed after CNS insult resultant from status epilepticus[1,7] and isolated head bullet wounds[3]
Intracranial abnormalities including raised intracranial pressure had been detected by brain Computed Tomography (CT) scan in 18/26 of the patients
Summary
Neurogenic pulmonary edema (NPE) is an age-old clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system (CNS) insult[1]. The connection between CNS injury and hemodynamic dysfunction was first described by Harvey Williams Cushing in 19031. This was followed by reports of cases in which acute pulmonary edema developed after CNS insult resultant from status epilepticus[1,7] and isolated head bullet wounds[3]. Bahloul et al identified features of left ventricular myocardial dysfunction in an echocardiographic study performed on previously healthy traumatic brain injury patients presenting with neurogenic pulmonary edema[5]. Current data estimate the prevalence of NPE following severe brain insults, like trauma, stroke, status epilepticus etc., to be about 50%17, rising up to 92% in fatal subarachnoid hemorrhage[18], being directly related to duration since insult[4]. There are no published data on a similar study to the best of our knowledge
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