Clinical SpotlightNeurocardiogenic Pulmonary Oedema: Initial Presentation of Multiple Sclerosis
Section snippets
Case Summary
A previously healthy 20 year-old male awoke as normal, developed a gradually worsening occipital headache at midday and shortness of breath that rapidly worsened over 10 min a few hours later. He arrived at the emergency department in respiratory distress with acute pulmonary oedema (APO) complaining of chest pain and vomiting. The previous day he had run 5 km as per his usual routine.
On examination he was afebrile with tachypnoea (30/min), reduced oxyhaemoglobin saturation (93–99%, 15 L/min O2),
Discussion
Here we report a rarely described initial manifestation of MS with APO and cardiac dysfunction secondary to a demyelinating lower brainstem lesion. Several case reports have shown new brainstem or cervical cord lesions associated with APO in relapses of MS [1], [2], [3], [4], [5]. Relapses with APO were typically preceded within hours or days by upper limb parasthesias, headache or visual disturbance [5]. Two cases have been fatal; one in a 14 year-old girl with relapsing-remitting MS [2] and
Acknowledgements
The authors would like to thank Dr Stephen Buchholz for helpful discussions and assistance with data collection.
References (12)
- et al.
Evidence for a hydrostatic mechanism in human neurogenic pulmonary edema
Chest
(1997) - et al.
Medullary lesion inducing pulmonary edema: a magnetic resonance imaging study
Ann Neurol
(1991) - et al.
Relapsing and remitting multiple sclerosis: pathology of the newly forming lesion
Ann Neurol
(2004) - et al.
Fatal neurogenic pulmonary edema in a patient with progressive multiple sclerosis
Mult Scler
(2008) - et al.
Unilateral neurogenic pulmonary oedema and severe left ventricular dysfunction secondary to acute multiple sclerosis exacerbation
Heart Lung Circ
(2009) - et al.
Acute pulmonary edema caused by a multiple sclerosis replase
J Neurol
(2011)
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Neurogenic pulmonary edema in pediatric multiple sclerosis: Patient report and summary of cases
2014, Pediatric NeurologyCitation Excerpt :This leads to the thought that there is a direct neurological influence on the pulmonary endothelium.6 Acute pulmonary edema has been described in patients with known multiple sclerosis and as the initial presenting symptom.7 We present a 14-year-old boy with previously diagnosed multiple sclerosis who presented with the acute onset of pulmonary symptoms (a few details of this patient's care were included in an earlier imaging review8).
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2013, Clinical Neurology and NeurosurgeryCitation Excerpt :This, in return, can disrupt the endocardial conduction system causing arrhythmias such as sinus bradycardia or paroxysmal atrial fibrillation [19,20]. There have even been reports of cardiogenic shock and pulmonary edema caused by MS relapse [21,22]. Although the catecholamine surge in acute brain lesions can lead to myocardial damage, such as demonstrated in Takotsubo syndrome, there is, as well, an association presence of demyelinating lesions in the brainstem and the disruption of central autonomic influence on cardiac and respiratory system [22,23].
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