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high-altitude cerebral edema (HACE)
Pathology:
- vasogenic cerebral edema
- hypoxia-driven increased cerebral blood flow beyond the limits of venous drainage capacity
Clinical manifestations:
1) symptoms occur 6-90 hours after ascent
2) insomnia
3) headache
4) ataxia
5) nausea/vomiting
6) lethargy -> obtundation
Management:
1) immediate return to lower elevation
2) supplemental oxygen
3) dexamethasone
4) acetazolamide may be useful for prevention
General
altitude sickness
cerebral edema
hypoxia
References
- Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18.
American College of Physicians, Philadelphia 2006, 2012, 2015, 2018.
- Wilson MH, Hargens AR, Imray CH.
Effects of Spaceflight on Astronaut Brain Structure.
N Engl J Med 2018; 378:581-583
PMID: 29414278 Free full text
http://www.nejm.org/doi/full/10.1056/NEJMc1716067