Neurogenic pulmonary edema in a child with traumatic epidural hematoma and brain herniation

Traumatic epidural hematoma is a common pathological condition following traumatic brain injury (TBI). Neurogenic pulmonary edema (NPE) is a rare but life-threatening complication, typically occurring in association with acute severe intracranial pathologies. Cases of pediatric traumatic epidural hematoma complicated by NPE are exceedingly rare. This case report describes a 1.5-year-old boy who suffered a large acute temporoparietal-occipital epidural hematoma with brain herniation after falling from a bed. Following an emergency epidural hematoma evacuation, the child developed high fever, respiratory distress, and copious pink frothy sputum, with chest CT showing large areas of high-density shadows in both lungs, leading to a diagnosis of NPE. Through aggressive supportive care, including mechanical ventilation, pharmacological treatment, and other supportive measures, the patient's respiratory function gradually improved, and pulmonary imaging abnormalities resolved rapidly within 48 hours, resulting in a favorable outcome. This case underscores the critical role of early recognition and timely intervention in managing acute traumatic epidural hematoma complicated by NPE, providing valuable insights for the clinical management of similar cases.