Podcast 625: High Altitude Cerebral Edema (HACE)

<p><strong>Contributor: Tom Seibert, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">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.  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The pathophysiology of HACE is thought to be due to increased cerebral blood flow and increased capillary permeability causing vasogenic edema and brain swelling</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">HACE is linked to extreme altitude</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Rapid descent should be done as soon as possible for this potentially fatal condition</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Oxygen can be supportive</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Dexamethasone is also typically indicated (8mg initially followed by 4 mg every 6 hours)</span></li> </ul> <p><strong><em>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</em></strong></p> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Jensen JD, Vincent AL.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/28613666/"><span style= "font-weight: 400;">High Altitude Cerebral Edema</span></a><span style="font-weight: 400;">. 2020 Aug 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 28613666.</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Hackett PH, Yarnell PR, Weiland DA, Reynard KB.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/30679208/"><span style= "font-weight: 400;">Acute and Evolving MRI of High-Alt