Objective:

To illuminate possible complications of high-altitude cerebral edema (HACE) and describe a case with profound cytotoxic lesions of the corpus callosum (CLOCC), the likes of which have never been published.

Background:

High-altitude cerebral edema is a potentially life-threatening condition. In severe nonfatal cases, MRI reveals extensive microbleeds that leave a lasting imprint. The pathophysiology of HACE seems to involve reversible vasogenic and cytotoxic edema, which can progress to microvascular disruption, leading to microbleeds as well as, in this case, unique cortical and subcortical micro-hemorrhaging.

Design/Methods:

This case report describes a 54-year-old Miami woman with a history of migraines who experienced severe symptoms during a vacation to Peru.

Results:

This patient initially experienced shortness of breath and headaches while hiking at Machu Picchu, at an elevation of 2,430 meters. Three days later, she was found unconscious and unresponsive. Upon initial evaluation at a local hospital in Cusco (altitude 3399m), Peru, the patient was intubated, sedated, and a brain CT scan revealed hyperdense areas in the corpus callosum. She was stabilized before being transferred to Lima, Peru (altitude 161m). Thirteen days after symptom onset, the patient returned home to South Florida, which is about sea-level, and presented to our facility (altitude 2m). Brain imaging performed on arrival revealed features of HACE, including extensive scattered microhemorrhages, cerebral edema as well as chronic blood products with extensive lesions in the corpus callosum. Following fluid resuscitation and a seven-day course of dexamethasone, there was clinical and radiographic improvement of cerebral edema.

Conclusions:

This case illustrates an atypical and unusual side effect of high altitude cerebral edema (HACE) that involves cytotoxic lesions of the corpus callosum (CLOCC) presented with complete corpus callosum hemorrhage as well as cortical and subcortical micro-hemorrhages. Such occurrences are extremely rare, with currently no similar radiological findings published.