High altitude cerebral edema: Difference between revisions
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[[File:PMC3775198 LI-30-193-g007.png|thumb|Head CT of HACE showing diffuse effacement of cerebral sulci and compression of ventricles.]] | |||
*Clinical diagnosis | *Clinical diagnosis | ||
Revision as of 18:39, 2 March 2020
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
- Uncertain mechanism, presumed cause is hypoxia leading to cerebral edema
- Headache, nausea/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]
- Supportive hyperventilation
- Dexamethasone 8mg initially (PO, IM, or IV), then 4mg q6hr
- Acetazolamide 250mg BID (better as ppx)
- Hyperbaric bag (Gamow bag) if available
Prevention
- Acclimatization, slow ascent
- 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.