Neurology Resident and Fellow Section

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Neurology Resident and Fellow Section A 61-year-old man presented with thunderclap headache followed by loss of consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette A 61-year-old man presented with thunderclap headache followed by loss of consciousness, two days after arriving in Atacama Desert, Andes Mountains in Chile at 4,000 meters. Examination showed coma. Mechanic ventilation was necessary. He had progressive improvement after transferred for low altitudes. Brain MRI is showed in Figure 1. © 2017 American Academy of Neurology Marussi VHR et al.

Imaging Marussi VHR et al. Figure 1: Brain MRI (A) Diffusion-weighted MRI shows hyperintense signal in the corpus callosum. (B) T2-weighted MRI discloses white matter changes caused by vasogenic edema. (C) T1-weighted MRI shows enhancement by contrast in globus pallidus. (D, E and F) SWI shows diffuse microhemorrages. These are brain MRI abnormalities observed in high-altitude cerebral edema (HACE). © 2017 American Academy of Neurology Marussi VHR et al.

High-altitude cerebral edema (HACE) Final diagnosis: High-altitude cerebral edema (HACE) HACE is a high morbidity condition characterized by vasogenic edema, causing acute consciousness impairment, due to physiological effects of travelling to high altitude1. Typical neuroimaging features encompass white matter changes, corpus callosum involvement and diffuse microhemorrages2. Treatment includes supplemental oxygen, descent and medication such as dexamethasone1. References: Wilson MH, Newman S, Imray CH. The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009;8:175-91. Schommer K, Kallenberg K, Lutz K, Bärtsch P, Knauth M. Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema. Neurology. 2013;81:1776-9. Marussi VHR et al. © 2017 American Academy of Neurology