Have you ever wondered what happens to our bodies when we climb a high mountain, that is, when we go far above sea level? Sometimes we go to high places to see beautiful views and experience new things. However, if we go without proper preparation, dangerous situations can arise when our bodies cannot handle the altitude. One such serious condition is called HACE (High-Altitude Cerebral Edema) .
What is HACE (High-Altitude Cerebral Edema)?
Simply put, HACE is a condition where your brain swells at high altitude . This is a dangerous condition that can even be life-threatening. Think about it, our bodies are used to the amount of oxygen in the environment we normally live in. However, when we suddenly go from sea level to a very high altitude, for example 4-5 kilometers (about 2.5-3 miles), the air there has very little oxygen. When our brain can't handle this lack of oxygen, it starts to swell in response. Our head is like a tight box, so when the brain swells, there is not enough space for it, and the pressure inside the head increases. This pressure damages the brain and our body starts to function erratically. This is called HACE. This condition can affect mountain climbers, people who go to mountainous areas, or anyone who goes to areas that are significantly higher than sea level.
What is the main cause of HACE?
The main cause of HACE is a condition called hypoxia . Hypoxia is when our body tissues, especially the brain, do not receive enough oxygen . When we go to a high altitude, the air there is less oxygen, so our body does not receive the amount of oxygen it needs. Because our body is not used to this low oxygen level, the function of important organs like the brain begins to deteriorate. This is the primary scientific cause of HACE.
What are the symptoms of HACE? How to recognize it?
The symptoms of HACE don't come on suddenly. They start out mild and then become more severe. So it's important to be aware of these symptoms, especially if you're a mountain climber.
Early Symptoms
These are some of the early warning signs of a HACE condition:
- Headache: This can be a little different than a normal headache, and can even be severe.
- Fatigue and tiredness: Feeling extremely tired even without doing any work.
- Dizziness and spinning sensation (Vertigo): You may feel dizzy even when standing.
- Nausea and vomiting: A feeling of stomach churning, possibly even vomiting.
- Drowsiness: Feeling sleepy all the time.
- Confusion: Inability to think clearly, not understanding what is happening, difficulty making decisions.
If you or someone you are with experiences these symptoms at high altitude, don't take it lightly , as this could be the beginning of HACE.
Severe Symptoms - If these occur, you need help immediately!
As the initial symptoms persist and the condition worsens, the following symptoms may appear. If you notice these , it is imperative to seek medical advice immediately :
- Severe headache: unbearable pain.
- Loss of balance (Ataxia): Inability to walk properly, staggering when asked to walk straight, like a drunk person.
- Extreme weakness: Loss of all life in the body.
- Slurred speech: Slurred speech , meaning words are not coming out clearly.
- Altered mental status: Forgetting where you are and what time it is, behaving strangely, seeing or hearing things that are not real.
- Loss of consciousness.
- Seizures.
Important: Often, people with HACE don't realize they're sick. They may think, "I'm just tired, I'll be fine in a little while." So, if you're hiking with a group and you notice a sudden change in your friend's behavior or speech (for example, someone who was fine suddenly starts slurring their words, or seems to be having trouble walking), don't ignore it . Get them down to a safe place as quickly as possible and seek medical attention immediately. Do not climb any higher for any reason.
Who is at higher risk of developing HACE?
This condition, called HACE, can affect anyone. It doesn't matter how experienced a climber you are or how old you are. However, some people are at a slightly higher risk:
- For those who have previously had altitude sickness: If you have previously experienced headaches and vomiting while climbing mountains, there is a small chance that you may also develop HACE.
- For those who engage in strenuous exercise: When you exercise hard at high altitude, your body needs more oxygen. But because there is less oxygen, the risk increases.
- For those who suddenly go from a low altitude to a very high altitude: The problem starts when the body doesn't have time to adjust to the change. It's best to go up slowly.
HACE usually affects people who are not accustomed to high altitudes, meaning they have never spent time in such an environment. The incidence of HACE is less than 1% of people who travel to altitudes between 4,000 and 5,000 meters (2.5 to 3 miles) above sea level. This makes it the least common form of altitude sickness.
What are the possible complications of HACE? How dangerous is it?
HACE is a serious condition that can lead to death if left untreated . Complications can occur within 24 hours of the onset of symptoms. The most dangerous complication is brain herniation . This occurs when the pressure inside the head (intracranial pressure) increases too much, causing parts of the brain to bulge and cutting off blood supply to the brain. This can cause severe brain damage, coma, and, unfortunately, death. That is why it is very important to act as soon as you notice the symptoms of HACE.
Are there any long-term effects of HACE?
The lack of oxygen (hypoxia) caused by HACE can sometimes have long-term effects. This means that some problems may remain even after the illness has resolved. For example:
- Memory loss.
- Cognitive impairment.
- Changes to your personality.
- Vision loss.
- Difficulty with speech and swallowing.
But, the best thing is, if HACE is recognized and treated early, the risk of such long-term effects is much lower. That's why it's always said that even if you get a minor illness at high altitude, don't ignore it.
How do doctors diagnose HACE?
If you get sick at high altitude and go to see a doctor, they will try to diagnose you with HACE as soon as possible, because treatment needs to start as soon as possible. The main things they do to diagnose the condition are:
- Neurological examination: This will check your balance, alertness, and speech.
- Asking about symptoms, medical history, and travel history: They will ask you about how you are feeling, whether you have had any previous illnesses, and how high you have traveled. Whether you have been to high altitudes is very important in diagnosing HACE.
Sometimes, the following tests may be done to confirm the diagnosis (these are not always necessary):
- Blood tests: Things like checking the number of white blood cells in the blood and checking the salt level.
- MRI (Magnetic Resonance Imaging) or CT scan (Computed Tomography scan) tests: These help to see if there is swelling in the brain or any other problems.
What are the treatments for HACE?
The first and most important step in treating HACE is to get to the bottom of the problem immediately . This is the best way to save lives. In addition, the following treatments are used:
- Descend at least 1000 meters (about half a mile): If possible, go with someone to help you. Don't exert yourself too much while going.
- Supplemental oxygen or using a portable hyperbaric chamber: These can provide oxygen to the body quickly.
- Administering medication:
- Dexamethasone, a corticosteroid drug: This reduces brain swelling.
- Acetazolamide: This medication also helps reduce swelling in the brain and help you adjust to altitude.
The doctor will determine the most appropriate treatment based on your condition.
How long does it take to recover after treatment?
Once you start treatment, you should start to feel better within a few days to a few weeks. It depends on how serious your condition is. But for most people, it doesn't take weeks, it just takes a few days.
What should someone with HACE expect?
HACE is a medical emergency. Therefore, early diagnosis and prompt treatment are the best way to prevent complications. It can occur in both experienced climbers and recreational climbers.
Imagine, you are planning to climb to the top of a mountain. Then, even if you have a little difficulty, you might think, 'We are almost to the top now, there is only a little more left, I can handle this.' That is the most dangerous thing. Because if you continue like this, the HACE condition will get worse. If not treated, it can be life-threatening.
So, if you or anyone in your group starts to feel tired, dizzy, or have a headache, don't hesitate to stop climbing and descend safely. HACE symptoms can worsen within a few hours. That's why it's important to be aware of the symptoms of HACE before you start climbing.
Can HACE be prevented? If so, how?
Yes, the best way to prevent HACE is to acclimatize your body to the altitude . This is called 'acclimatization'. Simply put, it's about allowing your body to slowly adjust to the changes in oxygen levels. Altitude sickness like HACE occurs when you suddenly go to an altitude for which your body is not prepared.
You can acclimatize yourself by climbing slowly and gradually. For example, if you are at an altitude of 2,500 meters (about 1.7 miles) above sea level, climb only 300-500 meters (about a mile) per day. That means you climb to that altitude one day, stay there overnight, and then climb a little higher the next day. This gives your body time to adjust to the new environment. This can be a challenge for some people, as it takes a little longer. However, it is best for your safety.
When should you seek immediate medical advice?
HACE is a medical emergency. If you feel sick, dizzy, or tired while at a high altitude, immediately go to a safe place and call emergency medical services. In Sri Lanka, you can call 1990 (Suvaseriya). If you are in a foreign country, call the emergency number of that country (e.g. 911). Don't waste time.
What are the important questions to ask the doctor?
If you have HACE, or suspect it, it's a good idea to ask your doctor questions like these:
- "Do I have HACE or another type of altitude sickness?"
- "How do I prepare my body before going to high altitudes?"
- "Will I have long-term effects from HACE?"
- "If I had HACE, could I climb mountains again?"
The answers to these questions will be very useful to you.
What is the difference between AMS and HACE?
A lot of people ask whether AMS (Acute Mountain Sickness) and HACE are two different things or one thing.
HACE (High-Altitude Cerebral Edema) is a rare and very severe form of AMS (Acute Mountain Sickness). HACE is sometimes called 'late AMS' or 'late stage AMS'.
AMS is a condition that occurs when you suddenly ascend to a high altitude. It can cause symptoms such as headaches, nausea, lightheadedness, and difficulty breathing.
Both of these conditions occur when our bodies don't get enough oxygen at high altitudes. Simply put, AMS is like a warning sign that, if ignored, can lead to a dangerous condition called HACE.
Finally, the most important thing to say to you! (Take-Home Message)
Climbing to the top of a mountain and experiencing it is truly a beautiful experience. But, when you are climbing, listen to your body. Even if the goal is so important to you that you think, 'I can't stop this, I'm only a little bit more away,' don't ignore the signals your body is giving you. If you feel the slightest symptoms of HACE (High-Altitude Cerebral Edema), immediately get to a safe place, that is, lower. If HACE is not treated, it can be life-threatening within a few hours. So don't delay. Take care of yourself and the other people climbing with you. Take action as soon as you start experiencing high altitude symptoms. Your life is precious!
` HACE, high altitude, cerebral edema, oxygen deprivation, headache, mountain climbing, altitude sickness, hypoxia, acclimatization
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