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High-altitude cerebral oedema mimicking stroke
Uday Yanamandra1, Amul Gupta, Sagarika Patyal
1Department of Internal Medicine, 153 General Hospital, Leh, Jammu & Kashmir, India.
BMJ Case Reports
|March 28, 2014
Summary
High-altitude cerebral oedema (HACO) can mimic stroke, presenting with focal neurological deficits. Prompt diagnosis and dexamethasone treatment are crucial for recovery, avoiding potentially disastrous thrombolysis.
Area of Science:
- Neurology
- Altitude Medicine
- Emergency Medicine
Background:
- High-altitude cerebral oedema (HACO) is a life-threatening condition prevalent in high-altitude regions.
- It typically presents with ataxia, elevated intracranial pressure (ICP), and coma.
- Timely diagnosis is critical to prevent fatal outcomes.
Observation:
- Two cases of HACO are presented, both initially mimicking acute ischaemic stroke.
- The first patient exhibited left-sided hemiplegia and declining consciousness; neuroimaging showed vasogenic oedema.
- The second patient had lower limb monoplegia with neuroimaging revealing an anterior cerebral artery territory perfusion deficit.
Findings:
- Both patients demonstrated clinical and neuroimaging features strongly resembling stroke.
- Treatment with dexamethasone led to dramatic clinical improvement in both cases.
- The diagnosis of HACO was supported by recent high-altitude travel, young age, lack of risk factors for atherosclerosis, and concurrent signs of raised ICP.
Implications:
- HACO can present with focal neurological deficits, challenging stroke diagnosis.
- Misdiagnosis could lead to inappropriate and harmful treatments like thrombolysis.
- Recognizing HACO's stroke-like presentation is vital for appropriate management and improved patient outcomes in high-altitude environments.
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