This scoping review aims to highlight the pathophysiology, discuss diagnostics, including non-invasive imaging modalities, and review the management of high-altitude cerebral edema.

High-altitude cerebral edema (HACE) is an emergency neuropathology that can occur at and above elevations of 2500 meters (8000 feet). The initial symptoms in HACE are ataxia with varying degrees of altered mentation. HACE is the least common but potentially the most fatal complication in the spectrum of acute mountain sickness. If unrecognized and not promptly managed, it may progress to coma and death as a result of brain herniation.

We conducted literature searches from PubMed, Google Scholar, Scopus, and Web of Science to identify relevant studies published from inception to 1st October 2024. The following strings were used to determine the articles: (“acute mountain sickness” OR “altitude” OR “high altitude” OR “hypoxia” OR “low atmospheric pressure” OR “simulated altitude”) AND (“cerebral edema” OR “high altitude cerebral edema” OR “brain swelling” OR “brain edema”). We included all the articles that discussed epidemiology, pathogenesis, diagnosis, or management of HACE. The articles that discussed cerebral edema due to neurological pathologies unrelated to high altitude were excluded from our study. Both authors used the Copen-Kappa statistical method to agree on selecting the articles.

We retrieved 1764 and selected 32 studies, including clinical trials, randomized controlled trials, meta-analyses, and systematic reviews that explained the pathophysiology and management of HACE. We included details including study design (origin of study, author), population characteristics (epidemiological profile), pathogenesis, diagnosis, and management of HACE.