Rapid Neurologic Deterioration in a Healthy Child at 4000 Meters: A Case Report and Literature Review of High Altitude Cerebral Edema in Children.

High altitude cerebral edema (HACE) is a rare but potentially fatal condition previously understudied in pediatric populations. We present a case of HACE in a previously healthy 10-y-old boy who rapidly developed neurologic symptoms at 4000 m on Mount Kilimanjaro. The child experienced headache, nausea, impaired consciousness, and ataxia before requiring assisted evacuation. Immediate descent of 2295 m resulted in complete recovery within 24 h with no long-term sequelae. A literature review of HACE in children revealed only 1 prior case series of 2 patients aged 12 and 16 y. This case report and literature review illustrate the challenges of recognizing and managing pediatric HACE in field conditions without medical support. Treatment guidelines for HACE in children suggest descent, supplemental oxygen, and dexamethasone, although these recommendations are extrapolated from adult data. Early recognition and descent remain the cornerstones of pediatric HACE management.