Emergency Medical Minute28 Dec 2020

Podcast 625: High Altitude Cerebral Edema (HACE)

Contributor: Tom Seibert, MD

Educational Pearls:

High altitude cerebral edema (HACE) is the end stage of acute mountain sickness and is diagnosed when patients develop neurologic dysfunction, ataxia, and altered mental status.
The pathophysiology of HACE is thought to be due to increased cerebral blood flow and increased capillary permeability causing vasogenic edema and brain swelling
HACE is linked to extreme altitude
Rapid descent should be done as soon as possible for this potentially fatal condition
Oxygen can be supportive
Dexamethasone is also typically indicated (8mg initially followed by 4 mg every 6 hours)

Editor's note: HACE can occur at altitudes as low as 8000 feet so don't automatically assume it can't/doesn't happen in the US

References

Jensen JD, Vincent AL. High Altitude Cerebral Edema. 2020 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 28613666.

Hackett PH, Yarnell PR, Weiland DA, Reynard KB. Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology. AJNR Am J Neuroradiol. 2019 Mar;40(3):464-469. doi: 10.3174/ajnr.A5897. Epub 2019 Jan 24. PMID: 30679208; PMCID: PMC7028681.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

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