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To the Editor: Dr Hackett and colleagues¹ elegantly elucidate the clinical imaging correlate with the pathophysiology of high-altitude cerebral edema (HACE). However, given the setting, the diagnosis of HACE is usually clearly clinical. This point was not emphasized in the article, which inadvertently may encourage physicians to obtain magnetic resonance images (MRIs) in countries like Nepal where people with HACE in the mountains are evacuated to Kathmandu.

The cost issue is relevant especially because many high-altitude locations are in developing countries where there is no health insurance for local people and many trekkers have no insurance either. An MRI is expensive for an individual to pay for out-of-pocket.

Buddha Basnyat, MD, MSc
Himalayan Rescue Association and Nepal International Clinic
Kathmandu

1. Hackett PH, Yarnell PR, Hill R, Reynard K, Heit J, McCormick J. High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology. JAMA. 1998;280:1920-1925. FREE FULL TEXT

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 . . . [Full Text of this Article]