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High-altitude cerebral edema - HACE

Critical urgency
-Very severe
Cerebral edema is part of acute mountain sickness (AMS), beyond an altitude of 8202 feet. Fluid accumulates in brain cells due to increased permeability of the capillaries secondary to less oxygen pressure. A lack of acclimatization, dehydration or a prior episode facilitates its onset. The symptoms are progressive with headache, nausea, vomiting, fatigue, dizziness, irritability, etc. It is a life-threatening emergency that requires immediate treatment by starting to descend and using oxygen therapy and dexamethasone.
Bibliographic references
  1. Scott A Gallagher, MD. Peter Hackett, MD. Jonathan M Rosen, MD. High altitude illness: Physiology, risk factors, and general prevention. UpToDate. Apr 15, 2015.
  2. Scott A Gallagher, MD. Peter Hackett, MD. Acute mountain sickness and high altitude cerebral edema. UpToDate. Mar 03, 2016.
  3. Wilson MH, Newman S, Imray CH. The cerebral effects of ascent to high altitudes. Lancet Neurol 2009; 8:175.
  4. Bailey DM, Bärtsch P, Knauth M, Baumgartner RW. Emerging concepts in acute mountain sickness and high-altitude cerebral edema: from the molecular to the morphological. Cell Mol Life Sci 2009; 66:3583.
  5. Schoene RB. Illnesses at high altitude. Chest 2008; 134:402.
Author
Dr. Oscar Garcia-Esquirol
Copyright
© TeckelMedical 2026

Symptoms

    Neurological symptoms: impaired speech, physical strength or feeling

    Coma

    Difficulty coordinating movements

    Change in mood and/or behavior

    Constant headache

Pre-hospital care recommendations

Descend below a safe altitude (< 8202 feet).
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