Commercial flight and patients with intracranial mass lesions: a caveat

2006 ◽  
Vol 105 (4) ◽  
pp. 627-630 ◽  
Author(s):  
Ludvic U. Zrinzo ◽  
Matthew Crocker ◽  
Laurence V. Zrinzo ◽  
David G. T. Thomas ◽  
Laurence Watkins
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Neurological Deterioration ◽  
Mild Degree ◽  
Airline Passengers ◽  
Life Threatening ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness ◽  
Commercial Flight ◽  
Mass Lesions

✓The authors report two cases of neurological deterioration following long commercial flights. Both individuals harbored intracranial space-occupying lesions. The authors assert that preexisting reduced intracranial compliance diminishes an individual’s reserve to accommodate the physiological changes resulting from a commercial flight. Airline passengers are exposed to a mild degree of hypercapnia as well as conditions that simulate those of high-altitude ascents. High-altitude cerebral edema following an ascent to great heights is one facet of acute mountain sickness and can be life threatening in conditions similar to those present on commercial flights. Comparable reports documenting neurological deterioration at high altitudes in patients with coexisting space-occupying lesions were also reviewed.

Headache at High Altitude

2018 ◽  
pp. 3-7
Author(s):  
Renee N. Salas
Keyword(s):  
High Altitude ◽  
Sea Level ◽  
Laboratory Testing ◽  
Acute Mountain Sickness ◽  
Vital Signs ◽  
Medical Practitioners ◽  
High Altitude Pulmonary Edema ◽  
Life Threatening ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness

Headache is a condition that medical practitioners commonly encounter with a broad differential that ranges from the benign to the life threatening. High altitude environments have unique diseases that present with headache, which this case will outline. Providers practicing at high altitude must be facile with diagnosing these conditions such as high altitude headache and acute mountain sickness. Astute providers must also assess for high altitude cerebral edema and high altitude pulmonary edema as they can co-exist with acute mountain sickness. Given that radiographic and laboratory testing are often not available, determining a diagnosis based on history and physical is essential with the knowledge that “normal” vital signs differ from that of sea level.

scholarly journals Perforation Peritonitis at High Altitude

2018 ◽  
Vol 56 (210) ◽  
pp. 625-628 ◽  
Author(s):  
Bhawana Amatya ◽  
Paleswan Joshi Lakhey ◽  
Prativa Pandey
Keyword(s):  
High Altitude ◽  
Distal Gastrectomy ◽  
Acute Mountain Sickness ◽  
Emergency Laparotomy ◽  
Delay In Diagnosis ◽  
First Case ◽  
Life Threatening ◽  
Perforation Peritonitis ◽  
Proper Diagnosis ◽  
Mountain Sickness

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential

scholarly journals Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema: An enhanced view from the High Andes

2021 ◽  
Author(s):  
Gustavo Zubieta-Calleja ◽  
Natalia Zubieta-DeUrioste
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Cerebral Edema ◽  
Acute Mountain Sickness ◽  
Point Of View ◽  
La Paz ◽  
Mountain Climbing ◽  
High Altitude Pulmonary Edema ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness

Background: Travelling to high altitude for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was mostly based on mountain climbing. Nowadays, altitude descent and evacuation are not mandatory in populated highland cities. Methods: We present how to diagnose and treat acute high altitude pathologies based on 50 years of high altitude physiology and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600m; 11,811ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI – IPPA) altitudeclinic.com.Results: Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are all medical conditions faced by some travelers. These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry, particularly after spending more than 20 days at sea level.Conclusions: Acute high altitude ascent diseases can be adequately diagnosed and treated without altitude descent. Traveling to high altitude should not be feared as it has many benefits;

scholarly journals Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema: A view from the High Andes

2021 ◽  
Author(s):  
Gustavo Zubieta-Calleja ◽  
Natalia Zubieta-DeUrioste
Keyword(s):  
Pulmonary Edema ◽  
High Altitude ◽  
Cerebral Edema ◽  
Acute Mountain Sickness ◽  
Healthy Children ◽  
Number Of Children ◽  
High Altitude Pulmonary Edema ◽  
High Altitude Cerebral Edema ◽  
Potential Risks ◽  
Mountain Sickness

Healthy children and those with pre-existing conditions traveling to high altitude may experience diverse physiologic changes. Individuals who are not acclimatized and ascend rapidly are at risk of developing acute high altitude illnesses (HAI), which may occur within a few hours after arrival at high altitudes, being acute mountain sickness (AMS) the most common. In very few cases, serious complications may occur, including High Altitude Pulmonary Edema (HAPE) and very rarely High Altitude Cerebral Edema (HACE). Moreover, the number of children and adolescents traveling on commercial aircrafts is growing and this poses a need for their treating physicians to be aware of the potential risks of hypoxia while air traveling. In this article we present 50 years of medical practice at high altitude treating these pathologies succesfully with no casualties.

scholarly journals The cerebral venous system and hypoxia

2016 ◽  
Vol 120 (2) ◽  
pp. 244-250 ◽  
Author(s):  
Mark H. Wilson ◽  
Christopher H. E. Imray
Keyword(s):  
Intracranial Pressure ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Venous Outflow ◽  
Edema Formation ◽  
Care Environment ◽  
Fluid Production ◽  
High Altitude Cerebral Edema ◽  
Blood Inflow ◽  
Mountain Sickness

Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static “Monro-Kellie” doctrine, which forms the basis of the “Tight-Fit” hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure.

Acute Mountain Sickness

2018 ◽  
pp. 36-39
Author(s):  
Nathaniel R. Mann
Keyword(s):  
Carbon Monoxide ◽  
Pulmonary Edema ◽  
High Altitude ◽  
Cerebral Edema ◽  
Carbon Monoxide Poisoning ◽  
Acute Mountain Sickness ◽  
Practical Management ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness

Altitude-related illness takes many forms, including cerebral edema, pulmonary edema, mountain sickness, and other conditions. Fatigue, dehydration, carbon monoxide poisoning, infections, and other illnesses can mimic or confound these processes. This chapter discusses common symptoms and treatments for high altitude cerebral edema, with a focus on practical management in field environments.

scholarly journals Greater free plasma VEGF and lower soluble VEGF receptor-1 in acute mountain sickness

2005 ◽  
Vol 98 (5) ◽  
pp. 1626-1629 ◽  
Author(s):  
Martha C. Tissot van Patot ◽  
Guy Leadbetter ◽  
Linda E. Keyes ◽  
Jamie Bendrick-Peart ◽  
Virginia E. Beckey ◽  
...  
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Significant Rise ◽  
Vegf Receptor ◽  
Vascular Endothelial ◽  
High Altitude Cerebral Edema ◽  
Mountain Sickness ◽  
Low Altitude ◽  
Endothelial Growth Factor ◽  
Free Plasma

Vascular endothelial growth factor (VEGF) is a hypoxia-induced protein that produces vascular permeability, and limited evidence suggests a possible role for VEGF in the pathophysiology of acute mountain sickness (AMS) and/or high-altitude cerebral edema (HACE). Previous studies demonstrated that plasma VEGF alone does not correlate with AMS; however, soluble VEGF receptor (sFlt-1), not accounted for in previous studies, can bind VEGF in the circulation, reducing VEGF activity. In the present study, we hypothesized that free VEGF is greater and sFlt-1 less in subjects with AMS compared with well individuals at high altitude. Subjects were exposed to 4,300 m for 19–20 h (baseline 1,600 m). The incidence of AMS was determined by using a modified Lake Louise symptom score and the Environmental Symptoms Questionnaire for cerebral effects. Plasma was collected at low altitude and after 24 h at high altitude, or at time of illness, and then analyzed by ELISA for VEGF and for soluble VEGF receptor, sFlt-1. AMS subjects had lower sFlt-1 at both low and high altitude compared with well subjects and a significant rise in free plasma VEGF on ascent to altitude compared with well subjects. We conclude that increased free plasma VEGF on ascent to altitude is associated with AMS and may play a role in pathophysiology of AMS.

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