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Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology
P H Hackett1, P R Yarnell2, D A Weiland3
1From the Altitude Research Center (P.H.H.), Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado hackett@hypoxia.net.
Abstract:
MR imaging of high-altitude cerebral edema shows reversible WM edema, especially in the corpus callosum and subcortical WM. Recent studies have revealed hemosiderin deposition in WM long after high-altitude cerebral edema has resolved, providing a high-altitude cerebral edema "footprint." We wished to determine whether these microbleeds are present acutely and also describe the evolution of all MR imaging findings. In 8 patients with severe high-altitude cerebral edema, we obtained 26 studies: 18 with 3T and 8 with 1.5T scanners, during the acute stage, recovery, and follow-up in 7 patients and acutely in 1 patient. Imaging confirmed reversible cytotoxic and vasogenic WM edema that unexpectedly worsened the first week during clinical improvement before resolving. The 3T SWI, but not 1.5T imaging, showed extensive microbleeds extending beyond areas of edema seen acutely, which persisted and with time coalesced. These findings support cytotoxic and vasogenic edema leading to capillary failure/leakage in the pathophysiology of high-altitude cerebral edema and provide imaging correlation to the clinical course.
Insights
High-altitude cerebral edema shows reversible white matter edema. Acute imaging reveals microbleeds using 3T SWI, persisting and coalescing over time, aiding understanding of this condition.
Area of Science:
- Neurology
- Radiology
- Altitude Medicine
Background:
- High-altitude cerebral edema (HACE) is a severe condition.
- Previous research identified hemosiderin deposition in white matter (WM) post-HACE.
- The acute presence and evolution of microbleeds in HACE remain unclear.
Purpose of the Study:
- To investigate the acute presence of microbleeds in HACE.
- To describe the evolution of all MR imaging findings in HACE.
- To correlate imaging findings with the clinical course of HACE.
Main Methods:
- MR imaging (3T and 1.5T) was performed on 8 patients with severe HACE.
- Imaging studies were conducted during acute, recovery, and follow-up stages.
- Susceptibility-weighted imaging (SWI) was utilized to detect microhemorrhages.
Main Results:
- Reversible cytotoxic and vasogenic WM edema was confirmed, worsening initially during clinical improvement.
- Extensive acute microbleeds, beyond edema areas, were detected by 3T SWI but not 1.5T.
- Microbleeds persisted and coalesced over time.
Conclusions:
- Findings support edema and capillary failure/leakage in HACE pathophysiology.
- 3T SWI is crucial for detecting acute microbleeds in HACE.
- Imaging findings correlate with the clinical course of HACE.
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