Altered Mental Status at High Altitude: Obstructive Hydrocephalus Mimicking High-Altitude Cerebral Edema (HACE).
Taylor Barg, Jaclyn Walker, Samara Levine et al.
✦ AI-curated · Sources linked
Case in brief
A 29-year-old woman developed amnesia, headache, confusion, and dysarthria after rapidly ascending a 4,404 m (14,267 ft) peak. Head CT showed hydrocephalus and apparent cerebral edema; she was hypotensive and required vasopressors during evacuation to a lower-altitude intensive care unit, where she initially received dexamethasone for presumed high-altitude cerebral edema (HACE). Further imaging and evaluation identified obstructive hydrocephalus caused by a colloid cyst, with little radiographic edema apart from compression related to the hydrocephalus. She also developed transient stress-induced cardiomyopathy and mixed neurocardiogenic shock.
What made this case unusual
Obstructive hydrocephalus from a colloid cyst mimicked HACE after rapid ascent; the apparent edema was largely attributable to hydrocephalus-related compression.
Diagnostic / clinical pearl
In altered mental status at high altitude, consider structural causes such as obstructive hydrocephalus alongside HACE, particularly when imaging shows hydrocephalus.
Why it matters
The case highlights that hypoxia-mediated increases in intracranial pressure may trigger high-altitude presentations that resemble HACE.