High Altitude Cerebral Oedema (HACE)

HACE is due to brain swelling.  Symptoms include confusion, loss of coordination, severe headache, drowsiness and loss of consciousness.  Symptoms of AMS are almost always present first.  Loss of co-ordination (ataxia) leads to patients being unable to ‘walk a straight line’.  This condition can be rapidly fatal.  The best treatment is rapid descent (>300m).   A hyperbaric bag should be used if rapid descent is not possible. Effective medications include dexamethasone and acetazolamide. Oxygen should be given if available.