ABSTRACT
Described in 1913 by Ravenhill as “puna of the nervous type” and reintroduced in the English language literature by Fitch half a century later, high altitude cerebral edema (HACE) is perhaps the most feared acute altitude illness as it can be associated with substantial morbidity and mortality if not recognized and treated promptly. After reviewing the epidemiology and important clinical aspects of the disease, including the timing and onset, symptoms and signs, and diagnostic approach, this chapter addresses the current understanding of disease pathophysiology and best practices for prevention and treatment. Basic laboratory studies are typically normal in HACE, aside from the possibility of a mild, nonspecific leukocytosis. Patients with isolated HACE typically have normal plain chest radiographs, while those with concurrent HAPE manifest alveolar opacities consistent with pulmonary edema. The approach to prevention of HACE is the same as that used for other forms of acute altitude illness.
