Fatal neurogenic pulmonary edema in a patient with progressive multiple sclerosis

Abstract

We report a case of fatal neurogenic pulmonary edema in progressive multiple sclerosis (MS). The patient had one isolated relapse-like episode. Six years later progressive disease began, lasting 5 years until unexpected death during sleep. Medico-legal autopsy revealed pulmonary edema and neuropathological examination showed infiltrations with lymphocytes and microglia in the respiratory centers of the medulla. More classical demyelinated lesions were found in the white matter of spinal cord and in the gray matter of the brain along with disseminated perivascular lymphocytic infiltrates. Medullary inflammation in progressive MS may result in sudden fatal respiratory failure.

Autonomic dysfunction in multiple sclerosis

“…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]. MS therapy itself can contribute or cause cardiac pathology.…”

Neurogenic pulmonary edema accompanying subarachnoid hemorrhage: case report

“…In addition to cardiogenic pulmonary edema, the differential diagnosis includes aspiration pneumonitis and pneumonia. In a postmortem study of a patient with progressive multiple sclerosis accompanied with fatal pulmonary edema, no explanatory findings such as tracheobronchial foreign bodies, pneumonia, sarcoidosis or cardiomyopathy were found indicating that the pulmonary edema could have been neurogenic [9]. Our patient had a prior history of bronchial asthma and the auscultation of lungs revealed rales and ronchi on admission.…”

Neurocardiogenic Pulmonary Oedema: Initial Presentation of Multiple Sclerosis

“…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].…”

“…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 another in a 30 year-old male with secondary progressive MS [3].…”