title: Acral paresthesias in the Andes and neurology at sea level.
abstract: BACKGROUND
  Thirty-nine percent of permanent altitude dwellers in the Andes experience acral paresthesias.
  
  
  METHODS
  Clinical examinations, sural nerve biopsies, and electrodiagnostic studies on peripheral nerves were performed on 15 men. Ten Cerro de Pasco (CP) natives living at 4,338 meters were biopsied. Three of these subjects had no burning feet/burning hands (BF/BH); three had BF/BH; and four had chronic mountain sickness (CMS), a maladaptation syndrome resulting from living in the Andes, all with BF/BH. Three patients with CMS were biopsied in Lima within hours after leaving CP. Two normal Lima natives were biopsied in Lima. Symptom scores for BF/BH and CMS score ratings were used. The nerves were assayed for Na+, K+ adenosine triphosphatase (ATPase), cytochrome oxidase (CO), substance P (SP), and endothelin (ET).
  
  
  RESULTS
  Low ATPase was inversely related to symptom scores and CMS scores (p < 0.001). Patients with CMS biopsied in normoxia (Lima) had ATPase levels similar to those of controls. Nerve motor conduction velocities and sensory action potentials were normal. CO was inversely related to age (p < 0.03) and no relation of SP to any variable was found. ET levels were lower in sea level natives (p = 0.04).
  
  
  CONCLUSIONS
  Acral paresthesias are associated with low ATPase in peripheral nerves. Lower ET levels of sea level natives likely reflect lowered release from vasa nervorum.
authors.affiliation: New Mexico Health Enhancement and Marathon Clinics Research Foundation, Albuquerque, NM 87122, USA.
authors.forename: O
authors.initials: O
authors.lastname: Appenzeller
authors.forename: P K
authors.initials: PK
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: Ponsford
authors.forename: J L
authors.initials: JL
authors.lastname: Gamboa
authors.forename: R
authors.initials: R
authors.lastname: Cáceda
authors.forename: P
authors.initials: P
authors.lastname: Milner
mesh_terms: D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000201:enzymology / Q000378:metabolism; D001706:Biopsy; D003576:Electron Transport Complex IV / Q000378:metabolism; D016232:Endothelins / Q000378:metabolism; D006801:Humans; D008297:Male; D009431:Neural Conduction / Q000502:physiology; D010292:Paresthesia / Q000201:enzymology / Q000378:metabolism / Q000503:physiopathology*; D010568:Peru; D000254:Sodium-Potassium-Exchanging ATPase / Q000378:metabolism; D013373:Substance P / Q000378:metabolism; D013497:Sural Nerve / Q000737:chemistry / Q000378:metabolism / Q000503:physiopathology
chemical_list: D016232:Endothelins; D013373:Substance P; D003576:Electron Transport Complex IV; D000254:Sodium-Potassium-Exchanging ATPase