What is high cerebral edema?

Altitude cerebral oedema or High Altitude Cerebral Oedema (HACE) is also a disease that can occur at altitude. It is more commonly seen from 3700 m, but can already occur from 2600 m. This disease also involves fluid accumulation. This is not in the lungs, but in the brain: the control centre of our body and therefore crucial for our survival. The fluid accumulation causes the brain to swell and take up more space. This increases the pressure, compromises the blood supply and the brain gets less and less nutrients and oxygen. The result is damage to the brain, which can ultimately be life-threatening.

HACE can be diagnosed when a person meets one of the two following criteria:

  • A change in mental status and/or coordination disorders with AMS symptoms
  • The presence of a change in mental status and coordination disorders without AMS symptoms

HACE can be fatal within hours, and survival depends on prompt diagnosis and treatment: rapid intervention is therefore vital.

The most effective treatment is immediate descent and/or evacuation, under supervision. Oxygen treatment is also recommended to restore saturation (>90%) (0.5 l - 2.0 l per minute). If descent is not possible at that time, and oxygen is not available, the use of a pressurised chamber is recommended. However, this should not be used as a substitute for descent or evacuation.

Medication can be a very effective means of stabilising or resolving HACE, but should not replace descent and should be used under the supervision of a (medical) professional. The following medications and dosages are recommended to be used in case of established HACE:

  • Dexamethasone
- Administer 8 mg immediately and then 4 mg every 6 hours - oral, intravenous or intramuscular administration
- 0.15 mg/kg - oral administration - every 6 hours - with a maximum of 4 mg per dose
HACE roadmap in brief:
1. Stop rising immediately
2. Immediate descent and/or evacuation
3. If descent or evacuation is not (yet) possible: oxygen therapy: 0.5 l - 2.0 l per minute, saturation >90% or use of a hyperbaric chamber
4. Medication under the guidance of a (medical) professional, if deemed necessary