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Topic 1610 Version 19.0 https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 19/24 7/5/23, 12:06 PM Neurogenic pulmonary edema - UpToDate GRAPHICS Causes of neurogenic pulmonary edema Major causes Epileptic seizures, particularly status epilepticus Intracranial hemorrhage (including intracerebral hemorrhage, intraventricular hemorrhage, epidural hemorrhage, subdural hemorrhage) Head injury Minor causes Guillain-Barr syndrome Multiple sclerosis with medullary involvement Nonhemorrhagic strokes Trigeminal nerve block Bulbar poliomyelitis Vertebral artery ligation Vertebral artery dissection Ruptured spinal arteriovenous malformation Air embolism Brain tumors Electroconvulsive therapy Induction of general anesthesia Colloid cyst Hydrocephalus Reye syndrome Bacterial meningitis Viral meningoencephalitis (including enterovirus-7) Cervical spinal cord injury Cryptococcal meningoencephalitis Hyponatremia High-voltage electrical injury Graphic 57483 Version 6.0 https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 20/24 7/5/23, 12:06 PM Neurogenic pulmonary edema - UpToDate Capillary hemodynamic forces Schematic representation of the capillary and interstitial fluid hydraulic and oncotic pressures controlling fluid movement across the capillary wall between the plasma and the interstitial fluid. The arrows point in the direction of fluid movement induced by each of the forces. : hydraulic pressure of the capillary; : oncotic pressure of P plasma; P : hydraulic pressure of the interstitial fluid; : oncotic pressure of interstitial fluid. cap p if if Graphic 55674 Version 2.0 https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 21/24 7/5/23, 12:06 PM Neurogenic pulmonary edema - UpToDate Etiology of acute respiratory distress syndrome* Etiology Clinical features Diagnostic tests Sepsis Fever, hypotension, leukocytosis, lactic acidosis, infectious source Appropriate clinical context and positive cultures Aspiration pneumonitis Witnessed or risk for aspiration, food, lipid laden macrophages, Presumptive diagnosis with negative cultures airway erythema on bronchoscopy Infectious pneumonia (including mycobacterial, viral, fungal, parasitic) Productive cough, pleuritic pain, fever, leukocytosis, lobar consolidation or bilateral infiltrates in an immunosuppressed patient Appropriate clinical context and positive respiratory cultures Severe trauma and/or multiple fractures History of trauma or fractures within the last week Diagnosis is apparent Pulmonary contusion History of chest trauma (blunt or penetrating), chest pain Presumptive diagnosis in the correct clinical context, negative cultures Burns and smoke inhalation Exposure to fire or smoke, cough, dyspnea, DIC, particulate matter on bronchoscopy, surface burns Presumptive diagnosis in the correct clinical context, negative cultures Transfusion related acute lung injury and massive transfusions History of transfusion, dyspnea during or shortly after transfusion Diagnosis of exclusion HSCT History of HSCT Diagnosis of exclusion Pancreatitis Abdominal pain, vomiting, risk actors (eg, gallstones, alcohol, viral infection) Elevated amylase and lipase, with or without abnormal imaging Inhalation injures other than smoke (eg, near drowning, History of inhalation exposure (eg, chlorine gas) Diagnosis of exclusion gases) Thoracic surgery (eg, post- History of surgery, Diagnosis of exclusion cardiopulmonary bypass) or other major surgery intraoperative ventilation, intraoperative transfusion Drugs (chemotherapeutic agents, amiodarone, radiation) New drugs or radiation exposure on history, lymphocytosis on lavage, lavage Diagnosis of exclusion, lung biopsy occasionally helpful https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 22/24 7/5/23, 12:06 PM Neurogenic pulmonary edema - UpToDate may have suggestive features of amiodarone toxicity ("foamy macrophages") but is nonspecific ARDS has over 60 etiologies. This is an abbreviated list of the common causes of ARDS. ARDS: acute respiratory distress syndrome; DIC: disseminated intravascular coagulation; HSCT: hematopoietic stem cell transplant; AEP: acute eosinophilic pneumonia; COP: cryptogenic organizing pneumonia; DAD: diffuse alveolar damage. Use of the term ARDS to describe conditions such as AEP or COP is somewhat controversial. However, some experts consider these a "subtype" of ARDS since they present in a similar fashion to ARDS, although the pathology of such entities is different from DAD, which is the classic pathology associated with ARDS. Similarly, while neurogenic pulmonary edema meets the definition of ARDS, since it causes hypoxemia and bilateral infiltrates in the absence of pulmonary edema due to heart failure, the pathology and clinical course is likely different. Similarly, embolism of fat, air, and amniotic fluid may mimic ARDS but it is uncertain as to whether they cause ARDS. Many patients with HSCT may develop a form of lung injury after transplant but the distinction between this and ARDS due to complications of HSCT (eg, pneumonia) is often unclear. Graphic 58759 Version 4.0 https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 23/24 7/5/23, 12:06 PM Neurogenic pulmonary edema - UpToDate Contributor Disclosures Matthew Wemple, MD No relevant financial relationship(s) with ineligible companies to disclose. Matthew Hallman, MD No relevant financial relationship(s) with ineligible companies to disclose. Andrew M Luks, MD Other Financial Interest: Springer (royalties) [Cardiopulmonary exercise testing]; Taylor and Francis (royalties) [High-altitude medicine and physiology]; Wolters Kluwer (book royalties) [Respiratory physiology and pulmonary pathophysiology]. All of the relevant financial relationships listed have been mitigated. Polly E Parsons, MD Employment: Alliance for Academic Internal Medicine [President and CEO]. All of the relevant financial relationships listed have been mitigated. Geraldine Finlay, MD No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/neurogenic-pulmonary-edema/print 24/24