Neurogenic pulmonary edema in traumatic brain injury

Case Report IntroductIonIn a patient with severe traumatic brain injury (TBI) complicated by immune thrombocytopenia (ITP) receiving platelet transfusions, on treatment with massive doses of steroids, identifying the cause for an acute respiratory insufficiency is challenging task even to this day.Common differential diagnoses would include transfusion-related acute lung injury (TRALI) and acute respiratory distress syndrome (ARDS).Neurogenic pulmonary edema (NPE) will usually be included in the list of differentials if the respiratory distress occurs immediately following the primary brain injury.The report stresses the importance of considering delayed onset NPE in the list of differentials when dealing with any acute respiratory decompensation that follows an acute central nervous system (CNS) event (such as seizures) occurring days after primary brain injury.A 29-year-old male admitted with severe traumatic brain injury following a road traffic accident was sedated and ventilated uneventfully for 72 h.On the fourth posttrauma day, after stopping sedation to assess readiness for extubation, he developed sudden onset desaturation; arterial blood gas showed severe diffusion defect with very low PaO 2 /FiO 2 ratio following an episode of generalized tonic-clonic seizure.The differential diagnoses and further management are discussed.