Magnetic resonance neuro-imaging findings in High-altitude cerebral edema (HACE) and probable correlation with its temporal evolution and pathogenesis

OBJECTIVE Evaluation of magnetic resonance neuro-imaging findings in high altitude cerebral edema (HACE) and probable correlation of these findings with the temporal evolution and pathogenesis of HACE. SETTING AND DESIGN Twenty-one devotees visiting a high-altitude cave temple in whom there was a clinical suspicion of high-altitude cerebral edema after the ascent were included in this study. All the patients met the criteria for diagnosis of acute mountain sickness (AMS) as well as HACE. MRI brain was done in all the 21 patients with special emphasis on diffusion and susceptibility weighted imaging. RESULTS Diffusion restriction with T2/FLAIR hyperintensity was present in the splenium of corpus callosum in all the 21 patients. Other sites involved were centrum semiovale and deep white matter (90.5%), middle cerebellar peduncles (66.7%) and posterior limb of internal capsule (57%). SWI revealed multiple tiny cerebral microbleeds in splenium, deep white matter and middle cerebellar peduncles. CONCLUSION This study suggests the evolution of diffusion restriction, T2/FLAIR hyperintensity and cerebral microbleeds in splenium of corpus callosum and white matter in HACE corresponds well with the temporal evolution of cytotoxic, ionic and vasogenic cerebral edema underpinning the role of brain water dyshomeostasis central to the pathogenesis of HACE.