Neurogenic Pulmonary Edema Associated With Pediatric Status Epilepticus

Abstract

Neurogenic pulmonary edema (NPE) can result from various central nervous system disorders such as brain malignancies, traumatic brain injuries, infections, and seizures. Although the pathogenesis is not completely understood, NPE creates an increase in pulmonary interstitial and alveolar fluid. In adults, it has been reported with prolonged seizure activity. In pediatric patients, pulmonary edema has rarely been reported after status epilepticus, and respiratory compromise is most often due to anticonvulsant-related respiratory depression. Treatment for NPE is largely supportive. If unrecognized, it can lead to hypoxia and respiratory arrest. We report a case of status epilepticus-related pulmonary edema in a female toddler, the youngest patient to be reported in the literature.

Neurogenic Pulmonary Edema Following Status Epilepticus: An Unusual Case

“…So far, there is only one reported case of NPE following febrile status epilepticus in this age group [3]. Such cases are rare and need constant vigilant management for speedy recovery.…”

“…However, presentation in hours to days (delayed onset) has been described [2]. The signs of NPE are quite non-specific [3,9]. It presents subjectively with a sudden onset of dyspnea, chest pain, worsening of expectoration, vomiting and weakness.…”

“…In pediatric patients, respiratory compromise has been attributed to anticonvulsant drug use and only isolated case reports exist for its association with recurrent seizures [3,5,6]. This is likely due to lack of awareness about the diagnosis and unpredictable nature of its etiology [2,3]. The diagnosis of NPE requires high index of clinical suspicion.…”

“…It manifests as an acute onset of pulmonary edema in the setting of central nervous system injury without previous cardiac pathology [2]. In adults, NPE could result from various central nervous system disorders such as subarachnoid hemorrhage following aneurysm rupture, brain malignancies, traumatic brain injuries, infections and prolonged seizure activity [3]. It develops within minutes, hours or days following injury and significantly complicates the overall clinical status of the patient [4].…”

Neurogenic pulmonary edema combined with febrile seizures in early childhood—A report of two cases

“…In adults, a variety of CNS events, such as head trauma, status epilepticus, stroke, infection, intracranial hemorrhage, and drug overdose, can cause this syndrome [1], [2], [3]. In contrast, NPE occurs less frequently in childhood, and there have been few reports about children that suffered NPE after non-febrile epileptic seizures [5], [6], [7], [8], [9], [10], [11]. There has only been one report about NPE caused by febrile seizures [3].…”