27 year-old with decreased mental status while hiking




CT Noncontrast



Axial FLAIR




DWI                                                                                                    Exponential ADC map (restricted diffusion should be bright)




T1 axial post Gad


Findings:

High T2 white matter symmetric along frontal lobes and corpus collosum splenium.  Nonenhancing and DWI negative

DDX:

Toxic/metabolic insult, ischemia, radiation,



Diagnosis:

High Altitude Cerebral Edema (HACE).

Discussion:

This hiker was climbing a mountain at approximately 4,000 meters and developed mental status changes and headache.  Vasogenic edema involving the corpus collosum in a characteristic finding.


Submitted by Dean Shibata, MD, UW Neuroradiology

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