We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. [casereports.bmj.com]

This article will briefly review normal adaptation to high altitude and then more extensive reviews of the clinical presentations, prevention, and treatments of these potentially fatal conditions. [ncbi.nlm.nih.gov]

• Asymptomatic

  They are usually asymptomatic and typically resolve over a few weeks. They may be found in HAPE and HACE, as well as the otherwise well person. Central scotomata can occur if the macula is involved. [lifeinthefastlane.com]

  […] short-term memory impairment, “third man syndrome,” cranial nerve palsies with the sixth cranial nerve most often affected, transient ischemic attacks with acute onset of aphasia, hemiparesis, visual field cuts, cerebral venous thrombosis, and seizures. 3 Asymptomatic [emsworld.com]

  Most hemorrhages are asymptomatic and transient. Their development does not mandate descent unless the macula is involved and visual acuity is compromised. [clinicaladvisor.com]

  If they then climb to 3,700 metres they will remain asymptomatic, but if they climb to 4,000 metres they would begin to experience altitude sickness symptoms. [climbkilimanjaroguide.com]

  For example, Sa0 2 is 80-86% in healthy individuals at 4200 m; values as low as 75% may occur in asymptomatic non-acclimatized individuals. Values significantly below this at elevations below 5500 m are usually diagnostic of HAPE. [high-altitude-medicine.com]

• Acutely Ill Patient

  Treatment • Descent is the highest priority. • Oxygen supplementation, descent, and steroid therapy. • In acutely ill patients who cannot descend, of steroids, supplemental oxygen, and a hyperbaric bag • Acetazolamide may be used as an adjunct 30. • Ataxic [slideshare.net]

• Exertional Dyspnea

  The symptoms of HAPE include: Increased dyspnea with exertion Dyspnea persisting during rest A feeling of suffocation with chest tightness Increased pulmonary edema with rattling or gurgling respirations Persistent cough with white, watery, or frothy [rnceus.com]

  HAPE Chest xray AMS/HACE may be present also, but otherwise the prodrome may be very subtle: fatigue out of proportion to exertion, dyspnea on exertion progressing to dyspnea at rest, a nonproductive cough. [high-altitude-medicine.com]

• Nausea

  At no point did he experience headache or nausea. The patient was evacuated by helicopter. He improved immediately after descent and recovered completely within a week. The speed of progression from AMS to HACE varies. [ncbi.nlm.nih.gov]

  […] and Vomiting, [[Nausea and Vomiting]]) Neurologic Manifestations Altered Mental Status (see Obtundation-Coma, [[Obtundation-Coma]]): ranges from lethargy to coma Headache (see Headache, [[Headache]]): usually poorly-responsive to analgesics Increased [mdnxs.com]

  […] gestational hypertension, globe rupture, HACE, headaches, HELLP, hemolysis, high altitude cerebral edema, histamine, histidine, hot and cold sensation reversal, hydralazine, hyperbaric, hypotension, influenza, labetalol, lassitude, magnesium, myalgias, nausea [roshreview.com]

  The symptoms of acute mountain sickness include headache, fever, fatigue, nausea, dizziness, anorexia, and sleep disturbances. This article describes the management of acute mountain sickness. [medlink.com]

  Ibuprofen can be used to treat the symptoms of mild altitude sickness such as headaches and nausea. [himalayatrekkingteam.com]

• Vomiting

  (see Nausea and Vomiting, [[Nausea and Vomiting]]) Neurologic Manifestations Altered Mental Status (see Obtundation-Coma, [[Obtundation-Coma]]): ranges from lethargy to coma Headache (see Headache, [[Headache]]): usually poorly-responsive to analgesics [mdnxs.com]

  […] oxygen, palpitations, peppery taste, preeclampsia, pregnancy, proteinuria, rhabdomyolysis, scombroid, seidel test, seizure, splenic artery aneurysm, steroids, surgery, tetanus, tingling, toxicology, vertigo, viral pneumonia, visceral artery aneurysm, vomiting [roshreview.com]

  Symptoms: Headache: 0 = none 1 = mild 2 = moderate 3 = severe/incapacitating Gastrointestinal: 0 = good appetite 1 = poor appetite or nausea 2 = moderate nausea or vomiting 3 = severe nausea or vomiting Fatigue and/or weakness: 0 = none 1 = mild 2 = moderate [clinicaladvisor.com]

  A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma. HACE can kill in only a few hours. [altitude.org]

  […] mean sea level Depending on the severity of symptoms, Acute Mountain Sickness can be classified into 3 types: Mild AMS Moderate AMS Severe AMS Jaw pain Family history of cardiovascular disease Breathing difficulty, fatigue, lightheadedness, nausea, and vomiting [dovemed.com]

• Loss of Appetite

  Symptoms include headache, tiredness, nausea or loss of appetite, irritability, and in more serious cases, shortness of breath, confusion, and even coma. Doctors diagnose altitude diseases primarily based on the symptoms. [msdmanuals.com]

  ACUTE MOUNTAIN SICKNESS Mild symptoms feels like a hangover / not feeling well: Headache Fatigue / Tiredness Nausea Shortness of Breath Loss of Appetite Disturbance in Sleep Dizziness 2. HIGH ALTITUDE PULMONARY EDEMA Water in Lungs. [himalayatrekkingteam.com]

  Preverbal children may develop loss of appetite, irritability, and pallor. AMS generally resolves with 12–48 hours of acclimatization. [wwwnc.cdc.gov]

  Symptoms of mild to moderate acute mountain sickness may include: Difficulty sleeping Dizziness or light-headedness Fatigue Headache Loss of appetite Nausea or vomiting Rapid pulse (heart rate) Shortness of breath with exertion Symptoms that may occur [medlineplus.gov]

  To meet the definition of AMS, other symptoms need to develop, such as loss of appetite, sometimes vomiting, weakness, dizziness, fatigue, and difficulty sleeping. AMS feels exactly like a bad hangover. [altitudemedicine.org]

• Diarrhea

  | Category: Blog, PodCast | Tagged: abdominal cramping, abdominal pain, altitude, bradycardia, cerebellar ataxia, ciguatera, coma, descent, diarrhea, embolization, encephalopathy, environmental, facial flushing, gestational hypertension, globe rupture [roshreview.com]

  The sensation is a little discomforting but not dangerous Taste alterations (some foods might taste weird) Nausea, vomiting and diarrhea – this is rare. These side effects should be identified during your test before departing for Kilimanjaro. [climbkilimanjaroguide.com]

• Headache

  Abstract Headache is the cardinal symptom of acute mountain sickness (AMS). The headache normally worsens, with increased cerebral affection and the development of high-altitude cerebral edema (HACE). [ncbi.nlm.nih.gov]

  A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma. HACE can kill in only a few hours. [altitude.org]

  He described headache and vomiting and gave names such as "the Great Headache Mountain" and "the Little Headache Mountain" to the mountains on his route. [medlink.com]

  (see Headache, [[Headache]]): usually poorly-responsive to analgesics Increased Intracranial Pressure (see Increased Intracranial Pressure, [[Increased Intracranial Pressure]]): without proper treatment, breain herniation/death may occur within 24 hrs [mdnxs.com]

• Ataxia

  However, there are no detailed analyses of ataxia in HACE. This paper considers the relation between ataxia and HACE and its frequency, significance, and importance. [ncbi.nlm.nih.gov]

  (see Ataxia, [[Ataxia]]) Other Manifestations Mild Fever (see Fever, [[Fever]]) Prevention of High-Altitude Cerebral Edema (HACE) General Measures Avoid Ethanol and Respiratory Depressants (see Ethanol, [[Ethanol]]) Avoid Extreme Cold Maintain Hydration [mdnxs.com]

• Confusion

  Symptoms commonly are headache, ataxia, and confusion progressing to stupor and coma. HACE is often preceded by symptoms of acute mountain sickness and coupled, in its severe form, with high-altitude pulmonary edema. [ncbi.nlm.nih.gov]

  Persons with this illness are often confused, and may not recognize that they are ill. The hallmark of HACE is a change in mentation, or the ability to think. There may be confusion, changes in behavior, or lethargy. [basecampmd.com]

  A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma. HACE can kill in only a few hours. [altitude.org]

  It is not to be confused with high altitude pulmonary oedema (HAPE), where fluid l eakage affects the air sacs of the lungs. The main cause of altitude sickness is the decreased oxygen concentration. [firstaidtrainingclasses.ca]

• Dizziness

  The symptoms of acute mountain sickness include headache, fever, fatigue, nausea, dizziness, anorexia, and sleep disturbances. This article describes the management of acute mountain sickness. [medlink.com]

  For those who get AMS, it generally occurs between 6,000 and 10,000 feet and causes mild symptoms such as a headache, dizziness, nausea and poor sleep. [verywell.com]

  /light-headedness Not dizzy Mild dizziness Moderate dizziness Severe dizziness 0 1 2 3 Difficulty sleeping Slept as well as usual Did not sleep as well as usual Woke many times, poor sleep Could not sleep at all 0 1 2 3 A total score of 3 to 5 = mild [patient.info]

  S&S • Dizziness • Light-headedness • Dimmed vision • Loss of consciousness Treatment • Oxygen, rapid descent, and correction of the underlying cause 17. [slideshare.net]

  If the person can breathe more quickly, their body will have more oxygen, resulting in the relief of some symptoms, such as nausea, dizziness, and headaches. [medicalnewstoday.com]

• Lethargy

  There may be confusion, changes in behavior, or lethargy. There is also a characteristic loss of coordination that is called ataxia. This is a staggering walk that is similar to the way a person walks when very intoxicated on alcohol. [basecampmd.com]

  The following are the commonly reported symptoms of HACE: Severe headache Vomiting Seizures Confusion Fatigue Lethargy Ataxia (lack of coordination) Irritability Difficulty speaking Blindness Paralysis of a limb Total paralysis Hallucinations Behavioural [firstaidtrainingclasses.ca]

  A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma. HACE can kill in only a few hours. [altitude.org]

  […] represent different points along a spectrum of disease Gastrointestinal Manifestations Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]]) Neurologic Manifestations Altered Mental Status (see Obtundation-Coma, [[Obtundation-Coma]]): ranges from lethargy [mdnxs.com]

• Hypocapnia

  Prolonged exertion in low oxygen also causes serious hypocapnia, lower carbon dioxide in the bloodstream, which may play a role in HACE. These factors cause the brain to swell with fluid, resulting in severe impairment. [en.wikipedia.org]

  […] high altitude, 4270 to 5490 m (14,000 to 18,000 ft) visitors to the mountainous regions of South America and the Himalayas •Extreme altitude, >5490 m (>18,000 ft) complete acclimatization generally is not possible accompanied by severe hypoxemia and hypocapnia [slideshare.net]

  Cerebral blood flow is decreased by hypocapnia, is increased by hypoxia, and consequently varies with the balance between arterial CO 2 and O 2. The role of this variation in symptomatology is unclear. [brooksidepress.org]

  Renal response to short-term hypocapnia in man. Kidney Int 1975;8:376-84. [ PUBMED ] 21. Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol 2004;5:136-46. [ PUBMED ] 22. Leaf DE, Goldfarb DS. [lungindia.com]

  This observation is most likely attributable to the cerebral vasodilatation caused by the hypoxic stimulus during submaximal exercise overriding the hypocapnia-induced vasoconstriction [37], [38]. [journals.plos.org]

The most important treatment for HAPE is descent. [altitude.org]

HACE Treatment Protocols Dr. Peter Hackett likes to say that there are three treatments for HACE: descent, descent, and descent. The need for descent is of utmost urgency. [high-altitude-medicine.com]

Portable hyperbaric chambers, such as the Gamow bag, may be used for treatment of HACE or HAPE. [clinicaladvisor.com]

BMJ 294: 1380–1382 CrossRef Google Scholar Ferreira P, Grundy P (1985) Dexamethasone in the treatment of acute mountain sickness. [link.springer.com]

Sickness is to ascend slowly and gradually to higher altitudes Please find comprehensive information on Acute Mountain Sickness regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]

What is the prognosis for HAPE? HAPE tends to get better quickly on descent and outlook (prognosis) is that there is usually complete recovery. [patient.info]

What is the prognosis for patients managed in the recommended ways? With adequate rest and adherence to treatment guidelines, individuals with mild or moderate AMS generally recover within a few days. HACE and HAPE are often fatal if left untreated. [clinicaladvisor.com]

The prognosis depends upon the severity of illness. In milder form the symptoms regresses completely within few days to week time. Highest numbers of AMS cases are reported from India in troops deployed at the height of 3500 to 5500 meters ( 6 ). [annalsofneurosciences.org]

Although HACE represents the least common form of altitude illness, it may progress rapidly to coma and death as a result of brain herniation within 24 hours, if not promptly diagnosed and treated. [1] [2] [3] [4] Etiology HACE generally occurs after [ncbi.nlm.nih.gov]

JAMA 280: 1920–925 CrossRef PubMed Google Scholar Hackett PH (1988) The cerebral etiology of high-altitude cerebral edema and acute mountain sickness. [link.springer.com]

Pathogenesis of high-altitude pulmonary edema: Inflammation is not an etiologic factor. JAMA 2002;287:2228-35. 37. Roche E, Romero-Alvira D. Role of oxygen free radicals in altitude-related disorders. Med Hypotheses 1994;42:105-9. [ PUBMED ] 38. [lungindia.com]

Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic factor [published correction appears in JAMA. 2002;288(9):1064]. JAMA. 2002;287(17):2228–2235. 33. Voelkel NF. High-altitude pulmonary edema. [aafp.org]

The epidemiology and clinical picture of HACE are reviewed. [ncbi.nlm.nih.gov]

Cell Mol Life Sci, 66/22; 3583–3594 Google Scholar Basnyat B, Lemaster J, Litch JA (1999) Everest or bust: A cross sectional, epidemiological study of acute mountain sickness at 4243 meters in the Himalayas. [link.springer.com]

Abstract This review focuses on the epidemiology, clinical description, pathophysiology, treatment, and prevention of high altitude cerebral edema (HACE). [ncbi.nlm.nih.gov]

An elite mountaineer reported severe acute mountain sickness and ataxia during an 8000-m expedition and concomitant use of transdermal nitroglycerin patches aimed to prevent frostbites. [ncbi.nlm.nih.gov]

Can I take drugs to prevent altitude sickness? As with everything, many 'quack' treatments and untested herbal remedies are claimed to prevent mountain sickness. [altitude.org]

HACE can be prevented by ascending to heights slowly to allow the body more time to acclimatize. Acetazolamide also helps prevent the condition. Untreated patients usually die within 48 hours. [en.wikipedia.org]