High-Altitude Cerebral Edema (HACE): The Denver/ Front Range Experience

ABSTRACT

High-altitude cerebral edema (HACE) is a potentially fatal metabolic encephalopathy associated with a time-dependent exposure to the hypobaric hypoxia of altitude. 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. Although HACE is mostly seen at altitudes above that of the Denver/Front Range visitor-skier locations, we report our observations over a 13-year period of skier-visitor HACE patients. It is believed that this is a form of vasogenic edema, and it is responsive to expeditious treatment with a successful outcome.

High-altitude cerebral edema (HACE) - encephalopathy - mountain sickness

REFERENCES

• 1 Hackett P H, Roach R C. High altitude medicine. In: Auerbach, PA, ed. Wilderness Medicine Saint Louis: CV Mosby 1995: 1-37
• 2 Hultgren H N. High altitude medicine.  Stanford, CA: Hultgren Publications; 1997
• 3 West J B. History of high altitude disease. In: High Life: A History of High Altitute Physiology and Medicine New York: Oxford University Press 1998: 132-163
• 4 Cavitt O. A Matter of Life and Death.  Golden, CO: Sanuk, Inc; 1991: Ch.1
• 5 Yarnell P R, Heit J, Reynard K, Hackett P H. High altitude cerebral edema: a clinical imaging correlation (abstract).  Ann Neurol . 1990;  28 281
• 6 Hackett P H, Yarnell P R, Hill R. High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology.  JAMA . 1998;  280 1920-1925
• 7 Honigman B, Theis M K, Koziol-MacLane J. Acute mountain sickness in a general tourist population at moderate altitudes.  Ann Intern Med . 1993;  118 587-592
• 8 Zafren K, Honigman B. High altitude medicine.  Emerg Med Clin North Am . 1997;  15 191-222
• 9 Bezruchka S. High altitude medicine.  Med Clin North Am . 1992;  76 1481-1497
• 10 Hultgren H, Honigman B, Theis K. High altitude pulmonary edema at a ski resort.  West J Med . 1996;  164 222-227
• 11 Houston C S. Acute pulmonary edema of high altitude.  N Engl J Med . 1960;  263 478-480
• 12 Hultgren H, Spickard W. Medical experiences in Peru.  Stanford Med Bull . 1960;  18 76-95
• 13 Hultgren H, Spickard W, Hellriegel K, Houston C. High altitude pulmonary edema.  Medicine (Baltimore) . 1961;  40 289-313
• 14 Fred H, Schmidt A M, Bates T, Hecht H. Acute pulmonary edema of altitude.  Circulation . 1962;  25 929-937
• 15 Kobayashi T, Koyoma S, Kubo K. Clinical features of patients with high altitude pulmonary edema in Japan.  Chest . 1987;  92 814-821
• 16 Houser R A, Lacey D M, Knight M R. Hypertensive encephalopathy, magnetic resonance imaging demonstration of reversible cortical and white matter lesions.  Arch Neurol . 1988;  45 1078-1083
• 17 Raroque H G, Orrison W W, Rosenberg G A. Neurologic involvement in toxemia of pregnancy: reversible MRI lesions.  Neurology . 1990;  40 167-169
• 18 Ay H, Buonanno F S, Schaefer P W. Posterior leukoencephalopathy without severe hypertension: utility of diffusion-weighted MRI.  Neurology . 1998;  51 1369-1376
• 19 Severinghaus J. Hypothetical roles of angiogenesis, osmotic swelling and ischemia in high altitude cerebral edema.  J Appl Physiol . 1995;  79 375-379
• 20 Schoene R B, Hackett P H, Henderson W R. High altitude pulmonary edema, characteristics of lung lavage fluid.  JAMA . 1986;  256 63-69
• 21 Joynt R J. Comments.  Neurology . 1998;  51 33A-34A
• 22 Appenzeller O. Altitude and the nervous system.  Arch Neurol . 1998;  55 1007-1009