Neurogenic pulmonary edema in traumatic brain injury
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In a patient with severe traumatic brain injury (TBI) complicated by immune thrombocytopenia (ITP) receiving platelet transfusions, on treatment with massive doses of steroids, identifying the cause of an acute respiratory insufficiency is challenging task even to this day. Common differential diagnoses would include transfusion-related acute lung injury (TRALI) and acute respiratory distress syndrome (ARDS). A 29-year-old male admitted with a severe traumatic brain injury following a road traffic accident was sedated and ventilated uneventfully for 72 h. On the fourth posttrauma day, after stopping sedation to assess readiness for extubation, he developed sudden onset desaturation; arterial blood gas showed severe diffusion defect with very low PaO2/FiO2 ratio following an episode of generalized tonic-clonic seizure. The differential diagnoses and further management are discussed...

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