Acute intraventricular hemorrhage triggered by coughing following return from high altitude: a case report and literature review

Background Exposure to high-altitude conditions can lead to significant physiological stress and elevate the risk of cerebrovascular incidents. Nevertheless, intraventricular hemorrhage (IVH) caused by a minor trigger such as coughing shortly after returning from brief high-altitude travel remains highly uncommon. Case Presentation A 30-year-old woman with no significant prior medical history developed a sudden thunderclap headache and began vomiting right after a strong cough. This occurred on the day she came back to Xi'an (400 m) from a four-day visit to Xining (2,260 m), where she had experienced considerable sleep disruption. A non-contrast head CT scan showed bleeding inside the ventricular system. Subsequent CT angiography (CTA) did not detect any aneurysms or vascular malformations. She was successfully treated with a neuronavigation-assisted endoscopic procedure to remove the intraventricular hematoma, along with intracranial pressure (ICP) monitoring. After surgery, she recovered smoothly and showed marked neurological improvement. Conclusion This case indicates that even brief stays at moderately high altitude may impair cerebrovascular self-regulation and increase stress on blood vessel walls. The resulting instability in blood flow during re-adaptation to lower elevation, combined with a sudden rise in intracranial pressure from a Valsalva-type action such as coughing, could lead to the rupture of susceptible vessels. Medical practitioners should consider this possible cause in cases of neurological emergency where there is a recent history of high-altitude exposure.