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Neurological Rehabilitation

(Kiosk 3) HACE Case: Cognitive Recovery in High Altitude Cerebral Edema: A Case Report

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Miriam L. Alpert, DO (she/her/hers)

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Michael Guthrie, MD

    Fellow Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

  • NB

    Nenad Brkic, MD

    Attending Physician
    Rehabilitation Institute of Chgo
    Chicago, Illinois

Case Diagnosis: 58 year-old female with high altitude cerebral edema (HACE).

Case Description or Program Description: A 58 year-old female developed HACE while visiting the Rocky Mountains (approximately 4,000 feet above sea level). On day 5 at high altitude, she was found unresponsive by family and taken to an acute care hospital. Brain magnetic resonance imaging (MRI) was remarkable for extensive foci of gradient susceptibility and T2 fluid attenuated inversion recovery (FLAIR) hyperintensities in the corona radiata, corpus callosum and internal capsule. She was treated with dexamethasone and N-acetylcysteine. She arrived to acute inpatient rehabilitation 11 days after presentation, and demonstrated disorientation, poor attention, slowed processing, emotional dysregulation, mild left-sided weakness, apraxia, and mild right visual field inattention.

Setting: Acute Rehabilitation Hospital

Assessment/Results: During her 12-day inpatient rehabilitation stay, she progressed in awareness, orientation, and left-sided strength. However, she still had difficulties with auditory processing, cognitive organization, working memory, and visual field deficits. She underwent cognitive rehabilitation including strategies use implementation and metacognitive training, and received amantadine during her inpatient stay. She was discharged home and continued therapy in day rehabilitation, where she still had slow processing speed, reduced retention of novel information, and impaired attention, reasoning, mental flexibility, and planning.

Discussion (relevance): Here we present a case of HACE with extensive imaging findings that correlate with ongoing cognitive deficits despite an almost 2-week course of inpatient rehabilitation. We plan to report on the patient’s clinical course at follow up after completion of an outpatient day rehabilitation program with further targeted cognitive rehabilitation.

Conclusions: Previous descriptions of rehabilitation programs for HACE are limited and range from complete spontaneous recovery to gradual improvements over months-years with various cognitive rehabilitation interventions. In the future, we would recommend the use of both restorative and adaptive cognitive rehabilitation as well as pharmacologic intervention to support processing speed in cases of cognitive impairment after HACE.