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Delayed onset of neurogenic pulmonary oedema following an evolving ischaemic stroke
  1. Alexandros Leonidas Liarakos1 and
  2. Patrick Tran2
  1. 1Acute Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Alexandros Leonidas Liarakos; alexandros.liarakos{at}


Any insult to the central nervous system can lead to the rare occurrence of neurogenic pulmonary oedema (NPO). It is usually associated with significant neurological injury (eg, subarachnoid haemorrhage or traumatic brain injury) with a relatively rapid onset. As an exception to this observation, we report a middle-aged woman who developed NPO 72 hours after the onset of a subtle but evolving right middle cerebral artery infarction confirmed on CT. Aggressive use of diuretics and vasodilators, as is normally the case for cardiogenic pulmonary oedema, can compromise cerebral blood flow and the ischaemic penumbra. This case illustrates how the diagnostic and therapeutic challenges were successfully addressed with the aid of bedside ultrasonography and close haemodynamic monitoring to reverse the respiratory failure while protecting the brain.

  • stroke
  • emergency medicine
  • medical management
  • neurology

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  • Contributors The contributors of this work include ALL for direct medical care, writing the article and the submission process; PT for writing the article, the submission process and advisory role. We are thankful to the patient for consenting to publish the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.