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May 19, 1999

High-Altitude Cerebral Edema

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(19):1794. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-19-jbk0519

To the Editor: The MRI studies of patients with HACE reported by Dr Hackett and colleagues1 suggest that the major mechanism for development of the syndrome is vasogenic, ie, requiring movement of fluid and protein out of the vascular compartment. Older reports support their conclusion. In studies of serum proteins and thyroid hormones in subjects taken abruptly from sea level to 4300 m, I reported a rapid and marked increase in serum albumin and thyroxine-binding protein concentrations at high altitude and suggested plasma dehydration as the cause.2 In another study,3 my colleagues and I reported a 13.2% and 19.6% decrease in plasma volume after 4 and 8 days at 4300 m, respectively, in subjects previously acclimatized at 1610 m. Since total body water was unchanged at 4300 m, we suggested that body water redistributes at high altitude out of the plasma in favor of interstitial or intracellular spaces.

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