Yanamandra Uday, Gupta Amul, Patyal Sagarika, Varma Prem Prakash
Department of Internal Medicine, 153 General Hospital, Leh, Jammu & Kashmir, India.
BMJ Case Rep. 2014 Mar 26;2014:bcr2013201897. doi: 10.1136/bcr-2013-201897.
High-altitude cerebral oedema (HACO) is the most fatal high-altitude illness seen by rural physicians practising in high-altitude areas. HACO presents clinically with cerebellar ataxia, features of raised intracranial pressure (ICP) and coma. Early identification is important as delay in diagnosis can be fatal. We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. Neuroimaging revealed features suggestive of vasogenic oedema. The second patient presented with monoplegia of the lower limb. Neuroimaging revealed perfusion deficit in anterior cerebral artery territory. Both patients were managed with dexamethasone and they improved dramatically. Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. Recent travel to high altitude, young age, absence of atherosclerotic risk factors and features of raised ICP concomitantly directed the diagnosis to HACO.
高原脑水肿（HACO）是在高原地区执业的乡村医生所见到的最致命的高原病。HACO的临床症状为小脑共济失调、颅内压（ICP）升高的表现及昏迷。早期识别很重要，因为诊断延误可能会致命。我们报告两例表现为类似中风的局灶性缺损的HACO病例。首例患者出现左侧偏瘫并伴有意识迅速恶化。神经影像学显示提示血管源性水肿的特征。第二例患者出现下肢单瘫。神经影像学显示大脑前动脉供血区灌注不足。两名患者均接受地塞米松治疗，病情显著改善。两例患者的临床表现和神经影像学都与急性缺血性中风极为相似。对这些患者进行溶栓治疗可能会带来灾难性后果。近期前往高原地区、年轻、无动脉粥样硬化危险因素以及颅内压升高的表现共同将诊断指向HACO。
