Altitude Tutorials

HACE (High Altitude Cerebral Oedema)

HACE is a build-up of fluid in the brain. HACE is life-threatening and requires urgent action.

What are the symptoms?

HACE is thought to be a severe form of acute mountain sickness. A severe headache, vomiting and lethargy will progress to unsteadiness, confusion, drowsiness and ultimately coma. HACE can kill in only a few hours. A person with HACE will find it difficult to walk heel-to-toe in a straight line – this is a useful test to perform in someone with severe symptoms of acute mountain sickness. HACE should also be suspected if a companion starts to behave irrationally or bizarrely.

Who gets HACE?

About 1% of people of ascend to above 3000m get HACE. The lowest altitude at which a case of HACE has been reported was 2100m. HACE can also occur in people with HAPE and vice versa. Factors that increase the risk of HACE are similar to those for acute mountain sickness and HAPE. The faster the rate of ascent and the higher the altitude, the more likely it is that HACE will develop. HACE is thought to occur mainly in trekkers or climbers who have ignored symptoms of acute mountain sickness and climbed higher rather than staying at the same altitude or descending.

What causes HACE?

The cause of HACE remains unknown. Several factors may play a role including increased blood flow to the brain. An increase in blood flow is a normal response to low oxygen levels as the body needs to maintain a constant supply of oxygen to the brain. However, if the blood vessels in the brain are damaged, fluid may leak out and result in HACE. Although we know that reactive chemicals are released when oxygen levels are low and that these chemicals can damage blood vessel walls, it still hasn’t been proven that the blood vessels in the brain are actually more leaky.

How is HACE treated?

Descent is the most effective treatment of HACE and should not be delayed if HACE is suspected. A Gamow bag, or portable altitude chamber, can be used as a temporary measure and, if available, oxygen and a drug called dexamethasone should be given.

Refs: Hackett P and Roach RC. High altitude cerebral oedema. HAMB 2004; 5(2):136-146

by A.A. Roger Thompson
Last updated June 2007

Do you know someone who has had HAPE? Please tell them about the International HAPE Database.

SUMMARY
HACE is a build-up of fluid in the brain HACE is life-threatening Thought to be a severe form of acute mountain sickness Symptoms include a severe headache, vomiting and lethargy, progressing to unsteadiness, confusion, drowsiness and ultimately coma Main treatment is descent; a Gamow bag, oxygen and dexamethasone are useful temporary measures if available

"Descent is the most effective treatment of HACE and should not be delayed if HACE is suspected"