Cases reported "Brain Edema"

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1/19. High-altitude cerebral edema (HACE): the Denver/Front Range experience.

    High-altitude cerebral edema (HACE) is a potentially fatal metabolic encephalopathy associated with a time-dependent exposure to the hypobaric hypoxia of altitude. Symptoms commonly are headache, ataxia, and confusion progressing to stupor and coma. HACE is often preceded by symptoms of acute mountain sickness and coupled, in its severe form, with high-altitude pulmonary edema. Although HACE is mostly seen at altitudes above that of the Denver/Front Range visitor-skier locations, we report our observations over a 13-year period of skier-visitor HACE patients. It is believed that this is a form of vasogenic edema, and it is responsive to expeditious treatment with a successful outcome.
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2/19. Seizure and hemiparesis at high-altitude outside the setting of acute mountain sickness.

    Neurologic problems at high altitudes are well known. What is probably less emphasized are neurologic problems at altitude outside the setting of high-altitude cerebral edema. Because neurologic symptoms for these kinds of problems at high altitude are often transient, neuroradiologic scanning for these problems is usually not done or reported. Furthermore, diagnostic testing facilities may be unavailable in these remote high-altitude settings. A patient is described here with transient seizure and right-sided hemiparesis at high altitude with no preceding symptoms of acute mountain sickness. Computed tomography of the head was obtained in a hospital at lower altitude where the patient was taken promptly. The findings of the scan revealed probable focal cerebral edema in the left parietal lobe in keeping with his temporary right-sided weakness. Possible treatment modalities on the mountain for this problem are also discussed.
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3/19. delirium at high altitude.

    A 35-year-old man on a trek to the Mount Everest region of nepal presented with a sudden, acute confusional state at an altitude of about 5000 m. Although described at higher altitudes, delirium presenting alone has not been documented at 5000 m or at lower high altitudes. The differential diagnosis which includes acute mountain sickness and high altitude cerebral edema is discussed. Finally, the importance of travelling with a reliable partner and using proper insurance is emphasized in treks to the Himalayas.
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4/19. Severe high-altitude cerebral edema on the Inca Trail.

    The following case history serves to reiterate the practical dangers of trekking at altitude. Despite the latter-day rise in the profile of altitude-related dangers, risks can still be understated to clients and poorly prepared for, even on commonly walked routes. Financial pressures can sometimes outweigh safety considerations.
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5/19. Transient high altitude neurological dysfunction: an origin in the temporoparietal cortex.

    This case report describes three separate episodes of isolated ataxia, hallucinations of being accompanied by another person, and bilateral dressing apraxia occurring in a single individual without prior warning signs. These symptoms are attributable to disruption of vestibular processing in the temporoparietal cortex or associated limbic structures. Neurological dysfunction at high altitude is usually ascribed to high altitude cerebral edema or acute mountain sickness. However, transient neurological symptoms occur abruptly at more extreme altitudes, often following vigorous exertion, without overt altitude-induced prodromes. These symptoms may be caused by intense neuronal discharge or neuronal synchronization as a feature of epileptic discharges or cortical spreading depression. Transient high altitude neurological dysfunction should be recognized as a separate complication of extreme altitude, distinct from high altitude cerebral edema.
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6/19. Irreversible subcortical dementia following high altitude illness.

    In this report, we present the cases of two 63-year-old women who developed high altitude cerebral edema complicated by the occurrence of permanent neuropsychiatric sequelae. They shared a similar clinical course, in that both developed disturbance of consciousness shortly after their arrival at Cuzco, peru (3500 m), and both developed persistent neuropsychiatric symptoms after resolution of the acute illness. Interestingly, in case 2 there was a 1-month lucid interval between remission of high altitude illness and occurrence of the irreversible neuropsychiatric sequelae. Brain computerized tomography in case 1 and brain magnetic resonance imaging in case 2 disclosed lesions in the globus pallidus bilaterally, suggesting that the neuropsychiatric symptoms in these patients were manifestations of subcortical dementia. The development of high altitude illness was considered to be attributable to mild restrictive lung impairment in case 1 and to a deficient ventilatory response to hypoxia in case 2. It must therefore be borne in mind that irreversible subcortical dementia may be associated with high altitude cerebral edema.
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7/19. Mini review of high altitude health problems in Ladakh.

    Ladakh is a sparsely populated area of Indian Himalaya lying at 3-4500 m altitude mainly consisting of arid desert. This paper will discuss high altitude health problems in Ladakh under the following headings. 1. Acute altitude illness: acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). 2. Effects of prolonged and permanent exposure to high altitude: (subacute and chronic mountain sickness). 3. Environmental dust and domestic fire pollution resulting in non-occupational pneumoconiosis and high prevalence of respiratory morbidity.
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8/19. Use of the Gamow Bag by EMT-basic park rangers for treatment of high-altitude pulmonary edema and high-altitude cerebral edema.

    As part of an emergency medical system protocol, national park service rangers certified at the level of an emergency medical technician-basic (EMT-B) are taught to recognize and treat high-altitude pulmonary edema and high-altitude cerebral edema. In sequoia and Kings Canyon National Parks, this is done with the assistance of physician on-line medical control as a backup. High-altitude pulmonary edema and high-altitude cerebral edema are both potentially fatal altitude illnesses that can be particularly problematic in the backcountry, where evacuation may be delayed. We report a case of high-altitude pulmonary edema and high-altitude cerebral edema occurring at moderate altitude that was successfully treated by park rangers with the Gamow Bag.
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9/19. Efficient breathing circuit for use at altitude.

    We describe a case report of a subject suffering high-altitude cerebral and pulmonary edema successfully treated with low flow rates of supplemental oxygen administered with a breathing system designed to conserve oxygen supplies at high altitude.
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10/19. Pregabalin-withdrawal encephalopathy and splenial edema: a link to high-altitude illness?

    A postherpetic-neuralgia patient abruptly discontinued pregabalin. Thirty hours later, unexplained nausea, headache, and ataxia developed, progressing to delirium 8 days later. magnetic resonance imaging indicated T2-hyperintense lesions of her splenium. Similar magnetic resonance imaging abnormalities, interpreted as focal vasogenic edema, develop in some epileptic patients after rapid anticonvulsant withdrawal. patients with high-altitude cerebral edema have similar splenial-predominant magnetic resonance imaging abnormalities that accompany these same neurological symptoms. This case is the first to associate anticonvulsant-withdrawal splenial abnormalities with neurological symptoms, with gabapentin-type anticonvulsants, and is among the first in nonepileptic patients, suggesting that sudden anticonvulsant withdrawal alone, unaccompanied by seizures, can initiate symptomatic focal brain edema. The similarity of this syndrome to high-altitude cerebral edema suggests a possible common pathophysiology and offers potential therapies.
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