No evidence of cerebral oedema in severe acute mountain sickness.
In a randomized, double-blind cross-over study 10 subjects were exposed to a simulated altitude of 4500 m for 10 h after administration of placebo, acetozolamide (250 mg bid) or theophylline (250 mg bid). T2-weighted magnetic resonances images (MRI) and diffusion weighted MRI were obtained directly after exposure to altitude under hypoxic conditions. Although eight of 10 subjects had moderate to severe acute mountain sickness (AMS), we found no evidence of cerebral oedema, irrespective of the medication taken. Almost all subjects showed a decrease in inner cerebrospinal fluid (iCSF) volumes (placebo - 10.3%, P= 0.02; acetazolamide - 13.2%, P= 0.008, theophylline -12.2%, n.s.). There was no correlation between AMS symptoms and fluid shift. However, we found a significantly positive correlation of large (>10 ml) iCSF volume and more severe AMS after administration of placebo (r = 0.76, P= 0.01). Moderate to severe AMS after high altitude exposure for 10 h is associated with a decreased iCSF-volume independent of AMS severity or medication without signs of cerebral oedema.
Fischer
R
R
Department of Medicine, Division of Pneumology, Medizinische Klinik Innenstadt, University of Munich, Ziemssenstrasse 1, D-80336 Munich, Germany. rfischer@medinn.med.uni-muenchen.de
Vollmar
C
C
Thiere
M
M
Born
C
C
Leitl
M
M
Pfluger
T
T
Huber
R M
RM
D000086:Acetazolamide / Q000627:therapeutic use*; D000532:Altitude Sickness / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D001921:Brain / Q000187:drug effects; D001929:Brain Edema / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015990:Placebo Effect; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013806:Theophylline / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D013806:Theophylline; D000086:Acetazolamide