Rapid Neurologic Deterioration in a Healthy Child at 4000 Meters: A Case Report and Literature Review of High Altitude Cerebral Edema in Children.
Oliver von Olnhausen, Henrik Hedelin, Olivia Kiwanuka
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Case in brief
A previously healthy 10-year-old boy developed headache, nausea, impaired consciousness, and ataxia at 4000 m on Mount Kilimanjaro. The presentation was consistent with high-altitude cerebral edema (HACE), and he required assisted evacuation. After an immediate descent of 2295 m, he recovered completely within 24 hours and had no long-term sequelae.
What made this case unusual
The report highlights the limited published experience with pediatric HACE: the authors’ review found only one prior case series, involving two patients aged 12 and 16 years. Recognition and management in field conditions without medical support were central challenges.
Diagnostic / clinical pearl
In a child at altitude, headache, nausea, altered consciousness, and ataxia should prompt consideration of HACE; early recognition and descent are central to management.
Why it matters
Pediatric HACE guidance on descent, supplemental oxygen, and dexamethasone is extrapolated from adult data, underscoring the limited evidence base for children.