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High Altitude Cerebral Edema


Presentation

  • In addition, the pathology and predominant pathophysiological mechanisms postulated to explain HACE are examined, and the present recommendations for the prevention and treatment of this dangerous and unusual form of brain swelling are discussed.[ncbi.nlm.nih.gov]
  • 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]
Dentist
  • Everest Disaster, Jon Krakauer describes the effects of HACE upon Dale Kruse, a forty-four-year-old dentist and one of the members of Scott Fischer's team: ‘Kruse was having an incredibly difficult time simply trying to dress himself.[en.wikipedia.org]
Unable to Stand
  • […] to stand Beware: Other diseases can mimic altitude-related illness: Since many of the findings of altitude-related illnesses are non-specific, the differential diagnosis may be extensive.[clinicaladvisor.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]
  • […] above the 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[dovemed.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 3 severe Dizziness[clinicaladvisor.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]
  • 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 3 severe Dizziness[clinicaladvisor.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]
  • […] 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]
  • 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]
Abdominal Cramps
  • 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, HACE[roshreview.com]
Jaw Pain
  • pain Family history of cardiovascular disease Breathing difficulty, fatigue, lightheadedness, nausea, and vomiting are some of the common signs and symptoms of Acute Mountain Sickness.[dovemed.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]
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]
  • 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]
  • Symptoms Confusion Fever Fast heart rate (tachycardia) Altered mental state Worsening coordination Severe headache Sports Medicine Evaluation and Treatment HACE is generally preceded by acute mountain sickness and high-altitude pulmonary edema (HAPE).[sportsmedtoday.com]
Dizziness
  • 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 3 severe Dizziness[clinicaladvisor.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]
  • 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 AMS[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]
Irritability
  • 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]
  • 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]
  • AMS in young children may present as any of the following; fussiness and irritability increased crying food refusal lack of energy, or increased sleepiness vomiting lethargy The same principles of prevention in adults apply to children.[altitudemedicine.org]
  • It needs to be used cautiously, however, because it can cause stomach irritation, euphoria or depression.[himalayatrekkingteam.com]
  • Symptoms such as a headache, mild dizziness, nausea, insomnia, and irritability can indicate dehydration and should not be ignored. In many cases, problems can be prevented by taking simple precautions.[verywell.com]
Stupor
  • 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]
  • Patients may exhibit ataxia and a depressed level of consciousness, which may progress to stupor or coma. Clinical findings include vomiting and exam findings of retinal hemorrhages and papilledema.[clinicaladvisor.com]
  • In patients with AMS, the onset of HACE is usually indicated by vomiting, headache that does not respond to non-steroidal anti-inflammatory drugs, hallucinations, and stupor.[en.wikipedia.org]
  • Symptoms include severe headache, confusion, ataxia, drowsiness, stupor and coma. Ataxia is the most sensitive sign, and should be considered an indication for descent.[lifeinthefastlane.com]

Workup

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]
  • 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]
  • 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]

Treatment

  • It is believed that this is a form of vasogenic edema, and it is responsive to expeditious treatment with a successful outcome.[ncbi.nlm.nih.gov]
  • Portable hyperbaric chambers, such as the Gamow bag, may be used for treatment of HACE or HAPE.[clinicaladvisor.com]

Prognosis

  • 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]

Etiology

  • 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]

Epidemiology

  • The epidemiology and clinical picture of HACE are reviewed.[ncbi.nlm.nih.gov]
  • Epidemiology Incidence : 0.5-1.0% in persons at 4000-5000 m altitude Physiology High Altitude with Inadequate Acclimatization Acute Mountain Sickness and High-Altitude Cerebral Edema (HACE) Represent Different Points Along a Spectrum of Disease (see Acute[mdnxs.com]
Sex distribution
Age distribution

Pathophysiology

  • In addition, the pathology and predominant pathophysiological mechanisms postulated to explain HACE are examined, and the present recommendations for the prevention and treatment of this dangerous and unusual form of brain swelling are discussed.[ncbi.nlm.nih.gov]

Prevention

  • 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]
  • 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]

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