High altitude cerebral edema: Difference between revisions

(Text replacement - "*Hyponatremia" to "*Hyponatremia")
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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 ↑ ICP)  
*Progressive neurologic deterioration in someone with [[acute mountain sickness]] or [[HAPE]] (due to ↑ ICP)  
*Almost never occurs at <8000ft
*Almost never occurs at <8,000ft


==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, and vomiting (not always present)
*Uncertain mechanism, presumed cause is hypoxia leading to cerebral edema
*Focal neuro deficits may be seen (3rd/6th CN palsies)
*[[Headache]], [[nausea/vomiting]] (not always present)
*Seizures are rare
*[[Focal neuro deficits]] may be seen ([[CN III palsy|3rd]]/[[abducens nerve palsy|6th]] CN palsies)
*[[Seizures]] are rare


==Differential Diagnosis==
==Differential Diagnosis==
{{High altitude DDX}}
{{High altitude DDX}}
*Dehydration
*[[Dehydration]]
*Exhaustion
*Exhaustion
*[[Hypoglycemia]]
*[[Hypoglycemia]]
*Hypothermia
*[[Hypothermia]]
*[[Hyponatremia]]
*[[Hyponatremia]]


==Evaluation==
==Evaluation==
*Clinical diagnosis
[[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
 
{{Expected SpO2 at altitude}}


==Management==
==Management==
[[File:Altitude flow sheet.png|thumb|High altitude management algorithm.]]
*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>
**Dexamethasone 8mg initially, then 4mg q6hr  
**Supportive hyperventilation
**Acetazolamide 250mg BID (better as ppx)
**[[Dexamethasone]] 8mg initially (PO, IM, or IV), then 4mg q6hr  
**Hyperbaric bag if available
**[[Acetazolamide]] 250mg BID (better as ppx)
**Hyperbaric bag (Gamow bag) if available


==Prevention==
==Prevention==
*Acetazolamide 125mg BID (250mg BID if greater than 100kg)
*Acclimatization, slow ascent
*Dexamethasone 4mg q6h PO or IV
*[[Acetazolamide]] 125mg BID (250mg BID if greater than 100kg)
*[[Dexamethasone]] 4mg q6h PO or IV


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

Revision as of 19:27, 2 March 2020

Background

  • Also known as HACE
  • Progressive neurologic deterioration in someone with acute mountain sickness or HAPE (due to ↑ ICP)
  • Almost never occurs at <8,000ft

Clinical Features

Differential Diagnosis

High Altitude Illnesses

Evaluation

Head CT of HACE showing diffuse effacement of cerebral sulci and compression of ventricles.
  • Typically a clinical diagnosis

Expected SpO2 and PaO2 levels at altitude[1]

Altitude SpO2 PaO2 (mm Hg)
1,500 to 3,500 m (4,900 to 11,500 ft) about 90% 55-75
3,500 to 5,500 m (11,500 to 18,000 ft) 75-85% 40-60
5,500 to 8,850 m (18,000 to 29,000 ft) 58-75% 28-40

Management

High altitude management algorithm.
  • Immediate descent is the treatment of choice
  • If descent not possible use combination of:
    • Supplemental O2 (goal SpO2 90%)[2]
    • 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

See Also

References

  1. Gallagher, MD, Scott A.; Hackett, MD, Peter (August 28, 2018). "High altitude pulmonary edema". UpToDate. Retrieved May 2, 2019.
  2. Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol 2004; 5:136-146.