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]

• 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 Graded Ascent (For Planned Final Altitude >3000 m) : [mdnxs.com]

  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]

  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]

  HAPE can also cause a fever and coughing up frothy spit. It is never normal to feel breathless when you are resting – even on the summit of Everest. This should be taken as a sign that you have HAPE and may die soon. [snowbrains.com]

  Fever is common, and resolves with treatment. In part because of the fever, there have been many deaths due to HAPE being misdiagnosed and mistreated as pneumonia. [high-altitude-medicine.com]

• Camping

  "When we're hiking to base camp, a pro like Conrad Anker is in the back of the line, taking his time, smelling the flowers. I think that helps." On our climb, the storm never let up, so we descended from Camp Muir, at 10,080 feet. [outsideonline.com]

  "I told my climbing partner to go on, that I would return to base camp." Coughing up blood, she says she could hear herself breathe as she lay down to rest, her brain a scramble of what to do. [tonic.vice.com]

  Of a total of reported 212 deaths on Everest from 1921 to 2006, 192 occurred above Base Camp, the last encampment before technical (roped) climbing begins. [sciencedaily.com]

  Many Yatris develop medical complications that are managed locally in medical camps erected specifically for the duration of the "Yatra." [lungindia.com]

  By the time Kruse arrived in Base Camp, he says, "it was still another three or four days before I could walk from my tent to the mess tent without stumbling all over the place."’ [en.wikipedia.org]

• Malaise

  They must also demonstrate one of the following signs and symptoms: lack of appetite, nausea, or vomiting exhaustion or weakness dizziness insomnia pins and needles shortness of breath upon exertion feeling sleepy general malaise swelling of the hands [medicalnewstoday.com]

  Shortness of breath Change in mental status General malaise Symptoms may worsen at night because of alterations in breathing. Moderate AMS With moderate AMS, normal activity becomes more difficult, and the person may have difficulty walking. [rnceus.com]

  Symptoms include headache, nausea, and malaise; if these start, climbers should descend until they disappear. If the swelling continues to worsen, it can become High-Altitude Cerebral Edema (HACE), a very serious condition. [outsideonline.com]

  Acute mountain sickness is the most common presentation of altitude illness and typically causes headache and malaise within six to 12 hours of gaining altitude. It may progress to high-altitude cerebral edema in some persons. [aafp.org]

• 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]

• Chills

  Other symptoms include dizziness, feeling chilled, trouble sleeping, loss of appetite or nausea, fatigue, and sometimes irritability. The Lake Louise Score is a scoring system of symptoms developed by experts at a conference in Lake Louise, Canada. [altitudemedicine.org]

• 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]

• Hypotension

  embolization, encephalopathy, environmental, facial flushing, gestational hypertension, globe rupture, HACE, headaches, HELLP, hemolysis, high altitude cerebral edema, histamine, histidine, hot and cold sensation reversal, hydralazine, hyperbaric, hypotension [roshreview.com]

  Despite the potential risk of hypotension, after treating many cases of HAPE I have not seen this. HAPE patients seem to be universally slightly hypertensive, and tolerate the sublingual nifedipine quite well. [high-altitude-medicine.com]

  Mild fever (38.30C), fitful sleep with arousal, tachycardia and hypotension are also reported in case of AMS ( 23 ). The prognosis depends upon the severity of illness. In milder form the symptoms regresses completely within few days to week time. [annalsofneurosciences.org]

• Flushing

  | 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]

  They are light weighing about 4.8 Kg (Certag bag) to 7kg (Gamow's bag) and require continuous inflation to flush out carbon dioxide. Slow compression and decompression and continuous evaluation of patient at hourly intervals is essential. [annalsofneurosciences.org]

• 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]

• Stroke

  Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. [casereports.bmj.com]

  Cellular hypoxia is the common final pathway of brain injury that occurs not just after asphyxia, but also when cerebral perfusion is impaired directly (eg, embolic stroke) or indirectly (eg, raised intracranial pressure after head injury). [ncbi.nlm.nih.gov]

  Heat illness falls into several categories including heat cramps, heat exhaustion, and heat stroke. Heat Stroke is a medical emergency. It strikes suddenly and with little warning. [verywell.com]

  Differential diagnoses include carbon monoxide poisoning, migraine, dehydration, exhaustion, hyponatremia, viral syndrome, alcohol hangover, bacterial infection, subarachnoid hemorrhage, stroke, and intracranial mass. [openanesthesia.org]

  Yanamandra U, Gupta A, Patyal S, Varma PP (2014) High-altitude cerebral oedema mimicking stroke. BMJ Case Rep2014. [jneuro.com]

• Insomnia

  Some, but not all, individuals will suffer from symptoms of AMS such as headache, insomnia, anorexia, nausea prior to transitioning to HACE. Some may also have concomitant High Altitude Pulmonary Edema (HAPE). [ncbi.nlm.nih.gov]

  Case Presentation: A healthy non-smoker non-drinker reported occipital headache, breathlessness, and insomnia after an uneventful stay of 70 days at 6400 m/21000 ft. His hemoglobin was 21 gm/dL. [ijtmgh.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]

  Insomnia at altitude is not necessarily caused by periodic breathing, but is thought to be secondary to cerebral hypoxia. Thus the respiratory stimulant acetazolamide is the sleeping tablet of choice. [high-altitude-medicine.com]

  It can cause headache, insomnia, dizziness, fatigue, nausea and vomiting. The next, more serious stage is high-altitude cerebral edema, also known as HACE, brain swelling that is potentially fatal. Lack of oxygen can directly damage brain cells. [scientificamerican.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]