High altitude cerebral edema - Revision history

Danbot: Add MedicationDose entries (dexamethasone, acetazolamide) with SMW annotations

2026-03-20T18:37:29Z

Add MedicationDose entries (dexamethasone, acetazolamide) with SMW annotations

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 *[[Acetazolamide]] 125mg BID (250mg BID if greater than 100kg)
 *[[Dexamethasone]] 4mg q6h PO or IV
 ==Disposition==

2021-05-23T00:18:11Z

Clinical Features

← Older revision		Revision as of 00:18, 23 May 2021
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	==Clinical Features==		==Clinical Features==
	*Will have clinical features of [[acute mountain ~~illness~~]] before HACE, as HACE is a progression from [[AMS]]		*Will have clinical features of [[acute mountain sickness]] before HACE, as HACE is a progression from [[AMS]]
	*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)		*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)
	**Ataxia at high altitude is cerebral edema until proven otherwise		**Ataxia at high altitude is cerebral edema until proven otherwise

2021-05-23T00:06:18Z

Prevention

← Older revision		Revision as of 00:06, 23 May 2021
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	*[[Acetazolamide]] 125mg BID (250mg BID if greater than 100kg)		*[[Acetazolamide]] 125mg BID (250mg BID if greater than 100kg)
	*[[Dexamethasone]] 4mg q6h PO or IV		*[[Dexamethasone]] 4mg q6h PO or IV

			==Disposition==
			*Admission for close monitoring, neurological checks
			*Recovery ranges from 2 to 21 days with 25% of patients recovering within 48 hours

	==See Also==		==See Also==

2021-05-23T00:03:10Z

Management

← Older revision		Revision as of 00:03, 23 May 2021
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	**[[Acetazolamide]] 250mg BID (better as ppx)		**[[Acetazolamide]] 250mg BID (better as ppx)
	**Hyperbaric bag (Gamow bag) if available		**Hyperbaric bag (Gamow bag) if available
			**Of note, furosemide, mannitol, and oral glycerol have all been studied but have undetermined effectiveness at this time.

	==Prevention==		==Prevention==

2021-05-23T00:00:51Z

Evaluation

← Older revision		Revision as of 00:00, 23 May 2021
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	**The presence of a change in mental status OR ataxia in a person with AMS		**The presence of a change in mental status OR ataxia in a person with AMS
	**'''OR''' the presence of BOTH a change in mental status and ataxia in a person without AMS		**'''OR''' the presence of BOTH a change in mental status and ataxia in a person without AMS

			*Lumbar puncture is not required, but if performed, will generally show elevated opening pressures (>44 mmH2O) and normal fluid analysis<ref>Medical Aspects of Harsh Environments Vol 2: Textbook of Military Medicine Series. Published by The US Army office of the surgeon general 2002. (Text, review)</ref>
			*CT or MRI may be confirmatory, but not necessary. Most beneficial to rule out alternative etiologies. If performed, may show signs of vasogenic edema. MRI will show white matter edema (increased T2 signal), particularly in the corpus callosum<ref>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(22):1920-1925.</ref>

	{{Expected SpO2 at altitude}}		{{Expected SpO2 at altitude}}

2021-05-22T23:54:48Z

Differential Diagnosis

2021-05-22T23:52:19Z

Evaluation

← Older revision		Revision as of 23:52, 22 May 2021
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	==Evaluation==		==Evaluation==
	[[File:PMC3775198 LI-30-193-g007.png\|thumb\|Head CT of HACE showing diffuse effacement of cerebral sulci and compression of ventricles.]]		[[File:PMC3775198 LI-30-193-g007.png\|thumb\|Head CT of HACE showing diffuse effacement of cerebral sulci and compression of ventricles.]]
	*~~Typically~~ a ~~clinical diagnosis~~		*The Lake Louise Consensus Criteria for HACE
			**The presence of a change in mental status OR ataxia in a person with AMS
			**'''OR''' the presence of BOTH a change in mental status and ataxia in a person without AMS

	{{Expected SpO2 at altitude}}		{{Expected SpO2 at altitude}}

2021-05-22T23:45:07Z

Clinical Features

← Older revision		Revision as of 23:45, 22 May 2021
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	==Clinical Features==		==Clinical Features==
			*Will have clinical features of [[acute mountain illness]] before HACE, as HACE is a progression from [[AMS]]
	*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)		*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)
	**Ataxia at high altitude is cerebral edema until proven otherwise		**Ataxia at high altitude is cerebral edema until proven otherwise

2021-05-22T23:44:07Z

Clinical Features

← Older revision		Revision as of 23:44, 22 May 2021
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	==Clinical Features==		==Clinical Features==
	*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)		*[[Altered mental status]], [[ataxia]], gait disturbance, stupor (most sensitive findings)
			**Ataxia at high altitude is cerebral edema until proven otherwise
	**Progresses to [[coma]] if untreated		**Progresses to [[coma]] if untreated
	*Uncertain mechanism, presumed cause is hypoxia leading to cerebral edema		*Uncertain mechanism, presumed cause is hypoxia leading to cerebral edema

2021-05-22T23:41:34Z

Background

← Older revision		Revision as of 23:41, 22 May 2021
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	*Also known as HACE		*Also known as HACE
	*Progressive neurologic deterioration in someone with [[acute mountain sickness]] or [[HAPE]] (due to ↑ ICP)		*Progressive neurologic deterioration in someone with [[acute mountain sickness]] or [[HAPE]] (due to ↑ ICP)
	*Almost never occurs at <8,000ft		*Least common form of [[acute mountain sickness]]
			*Typically occurs three to five days after arrival of high elevation
			*Almost never occurs at <8,000ft (~2000m)

	==Clinical Features==		==Clinical Features==