Neurogenic pulmonary edema as a manifestation of multiple sclerosis relapses

Neurogenic pulmonary edema (NPE) is a well-recognized manifestation of central nervous system insults (Theodore J, 1976). Both NPE and left ventricular failure can be seen in relapses of relapsing remitting multiple sclerosis (RRMS) (Melin J, 1996). This article presents two case reports demonstrating NPE presentation in the absence of left ventricular failure in addition to a review of the existing literature. The presented cases as well as previously published cases suggest NPE to be a rare but potentially fatal complication of MS relapse, especially in patients with medullary demyelination. This article seeks to encourage clinicians to maintain a high index of suspicion of NPE in MS patients presenting with unexplained cardiopulmonary symptoms and emphasizes early detection of brainstem lesions and continuous monitoring of cardiopulmonary function to support improved patient outcomes.