Atypical High-Altitude Cerebral Edema Presentation at an Altitude of Less Than 3000 Meters Elevation: A Case Report

INTRODUCTION: Atypical presentations of high altitude cerebral edema may have a stuttering course that can be similar to more common and benign pathology at a lower altitude than typically causes high altitude cerebral edema. CASE REPORT: A healthy 27-year-old male presented to a medical clinic situated at an altitude of 2829 meters with a “migraine” headache and nausea. He reported several episodes of ‘blurry vision’ each lasting seconds to a minute over the previous day. Symptoms had started four to five days after ascending from his home at sea level. The visual symptoms did not recur while he was in the clinic and his headache and nausea improved after oral medication. The physician recommended advanced imaging at the local hospital, but he declined and was discharged. The following day while riding a ski lift between 2830 and 3782 meters, he had a one-hour episode of visual disturbance with an intense headache. He was directed to proceed to the hospital for magnetic resonance imaging of the brain which demonstrated changes in his corpus callosum consistent with high altitude cerebral edema and he was evacuated to 1609 meters. CONCLUSION: An index of suspicion for high altitude cerebral edema must be maintained for any new neurological symptoms in unacclimatized individuals presenting to high alpine environments even those lower than typically associated with this high mortality condition.