Discussion about a patient experiencing headaches a month after being evacuated from Nepal with HACE.
A trekker who’s returned to the UK from a trek one month ago after being evacuated from the Everest Base Camp Trek with HACE. A month later she was still getting daily headaches, made worse recently when she started playing a wind instrument.
Local GP’s and a neurologist have not given her any explanation of why she’s still getting headaches and are planning an MRI later in the month.Whilst I’m familiar with immediate HACE management, I’d like to know if this is a common situation with patients post-HACE in your collective experience?
I don’t want to interfere with her management unnecessarily but would appreciate others perspective on this too.
Responses:
Although there is very little research on the after effects it has been largely assumed that HACE resolves quickly and leaves no long term consequences. However, from experience anecdotal evidence many HACE sufferers do experience some neuropsychiatric symptoms for periods of weeks or rarely, months following their episode.
This perhaps shouldn’t come as a surprise – the few MRI studies that have been conducted on HACE sufferers show changes, especially small areas suggesting haemorrhage, that may persist for months or more after an episode. In addition, wearing my intensivists hat, it’s worth emphasising that this was a life threatening illness that resulted from near catastrophic breakdown of the blood brain barrier. Following such illnesses we know that recovery often continues for a long time after discharge from hospital. You’ve only got to look at the depressingly low numbers of ITU patients who return to full time work at 1 year to see how recovery is often incomplete. Post ITU follow up services, patchy across the UK, recognise the need for structured physical therapy and psychological support tailored to the needs of the individual. Young, fit and previously healthy patients are often frustrated by their slow progress. Personally, I think this is often made worse by a lack of awareness. HACE sufferers rarely remember how sick they were. Doctors tell them that they’ll make a full and rapid recovery. But patients, their family and friends need to know just how ill they were. That the recovery may be slow and reaching out for counselling and other psychological support is perfectly acceptable.
