Reversible abnormalities of DWI in high-altitude cerebral edema

Abstract

A 29-year-old man presented with unsteadiness and leg weakness of 2 weeks’ duration. He had been on a hiking trip with two friends in the Andes. He started his hike from 2,000 m, having taken 2 days to ascend from sea level, reaching 3,500 m on day 1, 4,200 m on day 2, and 5,200 m on day 3. He developed tiredness and nausea and vomited once on his first day at 5,200 m. Over the next 2 days, he became disoriented and lethargic; he noticed increasing leg weakness and unsteadiness and was unable to walk independently. After 3 nights at this altitude, he crawled with the aid of his friends down to 4,200 m and then to 2,000 m over another day. Nausea and delirium improved, but his leg weakness and unsteadiness persisted, precipitating his referral on return to the UK. Examination of his cardiorespiratory system was normal. His gait was broad …