Neurogenic Pulmonary Edema Following Acute Subarachnoid Hemorrhage: A Case Report and Review of Emergency Management.

Neurogenic pulmonary edema (NPE) is a rare, life-threatening condition characterized by the accumulation of fluid in the lungs following acute central nervous system (CNS) injury. This case report discusses a 42-year-old woman who presented to the emergency department with sudden onset of severe headache followed by syncope. She was later found unconscious and experienced multiple episodes of seizures and respiratory distress. Initial chest X-ray (CXR) revealed clear lung fields, but two hours later, bilateral alveolar opacities indicative of pulmonary edema were noted. Brain computed tomography (CT) confirmed the presence of subarachnoid hemorrhage (SAH). NPE typically presents with symptoms similar to other causes of pulmonary edema, including dyspnea, frothy sputum, and wheezing. It often follows conditions such as epileptic seizures, traumatic brain injury, or intracranial hemorrhage. In this case, a significant amount of frothy sputum was observed during endotracheal intubation, further supporting the diagnosis of NPE. The primary focus of treatment for NPE involves managing the underlying CNS injury while providing adequate supportive care, such as oxygenation, mechanical ventilation, and intracranial pressure (ICP) monitoring. This case highlights the importance of rapid diagnosis and management of NPE in patients with acute CNS injuries. Early recognition and intervention are essential to prevent severe respiratory compromise and improve clinical outcomes. Physicians should be mindful of NPE as a potential complication in patients presenting with neurological emergencies.