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High altitude cerebral edema
From WikEM
Contents
Background
- Also known as HACE
- Progressive neurologic deterioration in someone with AMS or HAPE (due to ↑ ICP)
- Almost never occurs at <8000ft
Clinical Features
- Altered mental status, ataxia, gait disturbance, stupor (most sensitive findings)
- Progresses to coma if untreated
- Headache, nausea, and vomiting (not always present)
- Focal neuro deficits may be seen (3rd/6th CN palsies)
- Seizures are rare
Differential Diagnosis
High Altitude Illnesses
- Acute mountain sickness
- Chronic mountain sickness
- High altitude cerebral edema
- High altitude pulmonary edema
- High altitude peripheral edema
- High altitude retinopathy
- High altitude pharyngitis and bronchitis
- Ultraviolet keratitis
- Dehydration
- Exhaustion
- Hypoglycemia
- Hypothermia
- Hyponatremia
Evaluation
- Clinical diagnosis
Management
- Immediate descent is the treatment of choice
- If descent not possible use combination of:
- Supplemental O2 (goal SpO2 90%)[1]
- Dexamethasone 8mg initially, then 4mg q6hr
- Acetazolamide 250mg BID (better as ppx)
- Hyperbaric bag if available
Prevention
- Acetazolamide 125mg BID (250mg BID if greater than 100kg)
- Dexamethasone 4mg q6h PO or IV
See Also
References
- ↑ Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol 2004; 5:136-146.
