High altitude cerebral edema: Difference between revisions
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== Background == | ==Background== | ||
*Also known as HACE | *Also known as HACE | ||
*Progressive neurologic deterioration in someone with AMS or HAPE (due to | *Progressive neurologic deterioration in someone with AMS or HAPE (due to ↑ ICP) | ||
*Almost never occurs at | *Almost never occurs at <8000ft | ||
== Clinical Features == | ==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== | ==Differential Diagnosis== | ||
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*Hypothermia | *Hypothermia | ||
*Hyponatremia | *Hyponatremia | ||
==Diagnosis== | |||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
*Immediate descent is the treatment of choice | |||
*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> | |||
**Dexamethasone 8mg initially, then 4mg q6hr | |||
**Acetazolamide 250 mg BID (better as ppx) | |||
**Hyperbaric bag if available | |||
==Prevention== | ==Prevention== | ||
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==See Also== | ==See Also== | ||
[[High Altitude Medicine]] | *[[High Altitude Medicine]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Environ]] | [[Category:Environ]] | ||
Revision as of 07:23, 6 March 2016
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
Diagnosis
- 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 250 mg 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.