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Neurogenic Pulmonary Edema Clinical Presentation

  • Author: Tej K Naik, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
Updated: Dec 31, 2015


Neurogenic pulmonary edema (NPE) characteristically presents within minutes to hours of a severe central nervous system insult.

Sudden onset of dyspnea is the most common symptom; mild hemoptysis also may occur.



Physical findings include the following:

  • Tachypnea
  • Tachycardia
  • Bibasilar crackles
  • Respiratory distress
  • Pulmonary edema occurs but with normal jugular venous pressure and an absence of cardiac gallop, which should raise the possibility of a neurogenic cause
  • Fever - May occur secondary to the neurological disturbance (eg, subarachnoid hemorrhage)


Major causes

Minor causes

  • Multiple sclerosis with medullary involvement
  • Nonhemorrhagic strokes[17]
  • Bulbar poliomyelitis
  • Air embolism
  • Brain tumors
  • Electroconvulsive therapy
  • Bacterial meningitis
  • Cervical spinal cord injury
  • Intracranial endovascular therapy[18]
Contributor Information and Disclosures

Tej K Naik, MD Partner, Southern California Permanente Medical Group, Pulmonary and Critical Care Medicine, Kaiser Foundation Hospital, Fontana, California and Kaiser Foundation Hospital, Ontario, CA

Tej K Naik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.


Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, Society of Critical Care Medicine, California Thoracic Society, American Association for Respiratory Care

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Harold L Manning, MD Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School

Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Cory Franklin, MD Professor, Department of Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science; Director, Division of Critical Care Medicine, Cook County Hospital

Cory Franklin, MD is a member of the following medical societies: New York Academy of Sciences, Society of Critical Care Medicine

Disclosure: Nothing to disclose.


Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

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Neurogenic pulmonary edema in a patient with a subdural hematoma.
Progression of neurogenic pulmonary edema in the same patient in the image above, with subdural hematoma (day 2).
Factors leading to the development of neurogenic pulmonary edema in patients with subarachnoid hemorrhage.
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