High altitude cerebral edema: Difference between revisions
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*[[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 | ||
*Uncertain mechanism, presumed cause is hypoxia leading to cerebral edema | |||
*[[Headache]], [[nausea/vomiting]] (not always present) | *[[Headache]], [[nausea/vomiting]] (not always present) | ||
*[[Focal neuro deficits]] may be seen ([[CN III palsy|3rd]]/[[abducens nerve palsy|6th]] CN palsies) | *[[Focal neuro deficits]] may be seen ([[CN III palsy|3rd]]/[[abducens nerve palsy|6th]] CN palsies) | ||
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**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 (PO, IM, or IV), 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 | ||
==Prevention== | ==Prevention== | ||
*Acclimatization, slow ascent | |||
*[[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 | ||
Revision as of 21:26, 11 February 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.