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An account of respiratory aspects of neurological disease, such as the highly informative one presented,1 would be incomplete without mention of breathlessness resulting from neurogenic pulmonary oedema, characterised by an “increase in extravascular lung water in patients who have sustained a change in neurological condition”.2 Neurological disorders associated with this syndrome include subarachnoid haemorrhage, middle cerebral artery stroke, and cerebellar haemorrhage.2 Brain stem stroke, acute hydrocephalus due to colloid cyst of the third ventricle, closed head injury, and status epilepticus, were also documented as risk factors in a literature review by Smith and Matthay,2 who proposed, on the basis of their own study, that increased pulmonary vascular hydrostatic pressure might be a more significant aetiopathogenic mechanism than increased pulmonary capillary permeability.2 A more direct link between neurogenic myocardial damage and pulmonary oedema can be postulated when subarachnoid haemorrhage is complicated by reversible severe left ventricular dysfunction, as documented in two cases reported by Wellset al.3
We thank Dr Jolobe for his interest in our article; we did not cover neurogenic pulmonary oedema. We agree, however, that it can be a difficult clinical problem and therefore appreciate his contribution.
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