What is the most likely diagnosis for a 71-year-old male developing confusion and balance difficulty after ascending to high altitudes, specifically from 2700 meters (8858 feet) to 4000 meters (13,123 feet), presenting with initial symptoms of headache and nausea, suggestive of Acute Mountain Sickness (AMS)?

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Last updated: April 26, 2025 • View editorial policy

Differential Diagnosis for the 71-year-old male's symptoms

  • Single most likely diagnosis + High-Altitude Cerebral Edema (HACE): This condition is a severe form of altitude sickness that occurs when the brain swells due to high altitude. The patient's rapid ascent to high altitudes, initial symptoms of headache and nausea, followed by confusion and balance difficulties, are all consistent with HACE. The progression of symptoms despite continued ascent is particularly concerning for this diagnosis.
  • Other Likely diagnoses + High-Altitude Pulmonary Edema (HAPE): Although primarily affecting the lungs, HAPE can lead to hypoxia, which might cause confusion and balance issues. However, the primary symptoms of HAPE are shortness of breath and cough, which are not mentioned. + Dehydration: Travel and altitude changes can lead to dehydration, which might exacerbate symptoms of altitude sickness, including headache, nausea, and potentially confusion.
  • Do Not Miss diagnoses + Stroke: A stroke could present with sudden confusion and balance difficulties. Given the patient's age, it's crucial to consider vascular events, even though the context suggests altitude sickness. + Severe Dehydration leading to Heat Stroke or Hypothermia: Depending on the environmental conditions and the patient's hydration status, severe dehydration could lead to heat stroke or hypothermia, both of which can cause confusion and balance issues.
  • Rare diagnoses + Meningitis or Encephalitis: Infections affecting the brain could present with confusion and balance difficulties but would be unusual in this context without other symptoms like fever or stiff neck. + Inner Ear Problems: Conditions like labyrinthitis could cause balance difficulties but would not typically cause confusion and would not be directly related to altitude changes.

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