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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