Isolated high-altitude cerebral edema in the Himalayas: a case report

High-altitude cerebral edema (HACE) is the cerebral form of high-altitude sickness. It is a rare life-threatening condition that has been reported in 0.1-2% at altitudes above 3000 to 4000 m.

In this case, the authors have presented a 47-year-old male who was rescued from the Everest Region of Nepal at an altitude of 4900 after complaining of a severe headache, followed by an episode of vomiting, along with confusion and inability to walk on his own. He was treated with dexamethasone and other supportive measures in the emergency department. Magnetic resonance imaging (MRI) findings were suggestive of HACE. The patient was subsequently admitted for observation and neurological consultation.

HACE can occur as a sequela of acute mountain sickness (AMS), concurrently with high-altitude pulmonary edema (HAPE), or in isolated form. The exact pathophysiology of HACE remains incompletely understood. Clinical features include severe headache, vomiting, dizziness, loss of consciousness, drowsiness, ataxia, and eventually lead to coma. MRI is the investigation of choice. Management includes immediate descent, supplemental oxygen, dexamethasone, and hyperbaric therapy.

HACE has an unpredictable course, as it can progress rapidly. Proper acclimatization and taking appropriate precautions are essential when ascending to high altitudes.