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Multiple Sclerosis, Vol. 14, No. 5, 711-715 (2008)
DOI: 10.1177/1352458507087848

case-report

Fatal neurogenic pulmonary edema in a patient with progressive multiple sclerosis

S Bramow

Danish Multiple Sclerosis Research Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Laboratory of Neuropathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, stephan.bramow{at}rh.regionh.dk

JC Faber-Rod

Danish Multiple Sclerosis Research Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Laboratory of Neuropathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

C Jacobsen

Department of Forensic Pathology, Institute of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark

A Kutzelnigg

Department of Immunopathology, Center for Brain Research, Medical University of Vienna, Vienna, Austria

P Patrikios

Department of Immunopathology, Center for Brain Research, Medical University of Vienna, Vienna, Austria

PS Sorensen

Danish Multiple Sclerosis Research Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

H Lassmann

Department of Immunopathology, Center for Brain Research, Medical University of Vienna, Vienna, Austria

H Laursen

Laboratory of Neuropathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

We report a case of fatal neurogenic pulmonary edema in progressive multiple sclerosis (MS). The patient had one isolated relapse-like episode. Six years later progressive disease began, lasting 5 years until unexpected death during sleep. Medico-legal autopsy revealed pulmonary edema and neuropathological examination showed infiltrations with lymphocytes and microglia in the respiratory centers of the medulla. More classical demyelinated lesions were found in the white matter of spinal cord and in the gray matter of the brain along with disseminated perivascular lymphocytic infiltrates. Medullary inflammation in progressive MS may result in sudden fatal respiratory failure.

Key Words: chronic progressive multiple sclerosis • cortical demyelination • fatal outcome • pathology • pulmonary edema • nucleus tractus solitarius • spinal cord


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