Hyper-acute neurogenic pulmonary oedema in a prehospital setting: a case report

Introduction: Neurogenic pulmonary oedema (NPO) is a form of pulmonary oedema which can develop after an acute central nervous system (CNS) lesion, most often a subarachnoid haemorrhage (SAH). Its pathogenesis is associated with a surge of catecholamines which are released into the systemic circulation following an abrupt increase in intracranial pressure or a strategic CNS lesion. NPO typically presents with dyspnoea, tachypnoea, hypoxia, pink frothy sputum, bilateral crackles on auscultation, and bilateral infiltrates on chest X-ray in a few hours or days following the event. Case report: The following case report describes a case of hyper-acute NPO following a SAH, which presented as acute respiratory failure in the minutes after the event and required fast and aggressive treatment in the prehospital setting. Conclusion: The management of NPO is primarily focused on prompt diagnosis and treatment of a CNS event and supportive care.