title: Evidence of brain damage after high-altitude climbing by means of magnetic resonance imaging.
abstract: OBJECTIVE
  There are only anecdotal and small reports on brain systematic magnetic resonance imaging (MRI) studies in mountain climbers. The purpose of our work is to study the risk of brain lesions in mountain climbers by means of conventional MRI and magnetic resonance spectroscopy (MRS).
  
  
  METHODS
  We recruited 35 climbers consecutively (12 were professional and 23 were amateur) in 4 expeditions without supplementary oxygen: 12 professionals and one amateur went up to Mt. Everest (8848 m), 8 amateurs to Mt. Aconcagua (6959 m), 7 amateurs to Mont Blanc (4810 m), and 7 amateurs to Mt. Kilimanjaro (5895 m). The mean age was 33.8 years (range: 22-46). All of them underwent general medical examination, standard blood tests, and MRI of the brain after the expeditions. MRI also was carried out in a control group of 20 healthy subjects. Single-voxel MR spectroscopy was carried out in 14 amateur subjects after the expeditions and in 10 healthy controls. As outcome measures, we evaluated changes in the hematocrit value, presence of cerebral lesions on MRI, as well as atrophy and dilatation of Virchow-Robin spaces, and differences in the metabolite ratios obtained from brain MRS in comparison with controls.
  
  
  RESULTS
  Only 1 in 13 of the Everest climbers had a normal MRI; the amateur showed frontal subcortical lesions, and the remainder had cortical atrophy and enlargement of Virchow-Robin spaces but no lesions. Among the remaining amateurs, 13 showed symptoms of high-altitude illness, 5 had subcortical irreversible lesions, and 10 had innumerable widened Virchow-Robin spaces. Conversely, we did not see any lesion in the control group. We found no significant differences in the metabolite ratios between climbers and controls.
  
  
  CONCLUSIONS
  We conclude that there is enough evidence of brain damage after high altitude climbing; the amateur climbers seem to be at higher risk of suffering brain damage than professional climbers.
authors.affiliation: Magnetic Resonance Unit, Clinica Quirón de Zaragoza, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Fayed
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Modrego
authors.forename: Humberto
authors.initials: H
authors.lastname: Morales
mesh_terms: D000328:Adult; D000531:Altitude; D000532:Altitude Sickness / Q000175:diagnosis* / Q000473:pathology; D001921:Brain / Q000473:pathology*; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009051:Mountaineering / Q000293:injuries*