Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema

Neurology. 2013 Nov 12;81(20):1776-9. doi: 10.1212/01.wnl.0000435563.84986.78. Epub 2013 Oct 9.


Objective: Based on recent findings of microhemorrhages (MHs) in the corpus callosum (CC) in 3 individuals after nonfatal high-altitude cerebral edema (HACE), we hypothesized that hemosiderin depositions in the brain after high-altitude exposure are specific for HACE and remain detectable over many years.

Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had experienced HACE, 8 high-altitude pulmonary edema, 11 severe acute mountain sickness, and 8 had climbed to altitudes ≥6,962 m without developing any high-altitude illness. HACE was defined as ataxia necessitating assistance with walking and/or decreased consciousness. Within <1 to 38 months after the qualifying incident, MRI of the brain was performed using a 3-tesla scanner and high-resolution susceptibility-weighted magnetic resonance sequences for detection of hemosiderin depositions, which were quantified by a score.

Results: Unequivocal MHs located in the splenium of the CC were found in 8 subjects and questionable MHs were found in 2 subjects 1 to 35 months after HACE. They were located outside the CC in 5 more severe cases. MHs remained unchanged in those reexamined after 12 to 50 months. A few unequivocal MHs in the splenium of the CC were found in one subject after severe acute mountain sickness, while one subject with high-altitude pulmonary edema and 2 of the extreme altitude climbers had questionable lesions. In all other subjects, MHs were unequivocally absent.

Conclusions: MHs detectable by susceptibility-weighted MRI predominantly in the splenium of the CC are long-lasting footprints of HACE.

MeSH terms

  • Altitude Sickness / complications*
  • Altitude Sickness / diagnosis
  • Altitude Sickness / pathology
  • Brain / metabolism*
  • Brain Edema / etiology*
  • Brain Edema / pathology*
  • Chi-Square Distribution
  • Corpus Callosum / pathology
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Hemosiderin / metabolism*
  • Humans
  • Hypertension, Pulmonary / complications*
  • Magnetic Resonance Imaging
  • Male


  • Hemosiderin

Supplementary concepts

  • Pulmonary edema of mountaineers