High altitude cerebral edema: Difference between revisions
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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) | ||
**Progresses to coma if untreated | **Progresses to [[coma]] if untreated | ||
*Headache, nausea | *[[Headache]], [[nausea/vomiting]] (not always present) | ||
*Focal neuro deficits may be seen (3rd/6th CN palsies) | *[[Focal neuro deficits]] may be seen (3rd/6th CN palsies) | ||
*Seizures are rare | *[[Seizures]] are rare | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{High altitude DDX}} | {{High altitude DDX}} | ||
*Dehydration | *[[Dehydration]] | ||
*Exhaustion | *Exhaustion | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
*Hypothermia | *[[Hypothermia]] | ||
*[[Hyponatremia]] | *[[Hyponatremia]] | ||
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*Immediate descent is the treatment of choice | *Immediate descent is the treatment of choice | ||
*If descent not possible use combination of: | *If descent not possible use combination of: | ||
**Supplemental O2 (goal SpO2 90%)<ref>Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol 2004; 5:136-146.</ref> | **Supplemental [[O2]] (goal SpO2 90%)<ref>Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol 2004; 5:136-146.</ref> | ||
**Supportive hyperventilation | **Supportive hyperventilation | ||
**Dexamethasone 8mg initially, then 4mg q6hr | **[[Dexamethasone]] 8mg initially, then 4mg q6hr | ||
**Acetazolamide 250mg BID (better as ppx) | **[[Acetazolamide]] 250mg BID (better as ppx) | ||
**Hyperbaric bag (Gamow bag) if available | **Hyperbaric bag (Gamow bag) if available | ||
Revision as of 01:33, 2 September 2019
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/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, then 4mg q6hr
- Acetazolamide 250mg BID (better as ppx)
- Hyperbaric bag (Gamow 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.