title: Cerebral Edema in Chronic Mountain Sickness: a New Finding.
abstract: We observed patients with chronic mountain sickness (CMS) in our clinic who developed progressive neurological deterioration (encephalopathy) and we wished to investigate this. We studied nine such CMS patients, and compared them to 21 CMS patients without encephalopathy, and to 15 healthy control subjects without CMS. All 45 subjects lived permanently at 3200-4000 m. Measurements at 2260 m included CMS symptom score, multi-slice CT, perfusion CT, pulse oximetry (SpO2%), and hemoglobin concentration (Hb). One patient had MRI imaging but not CT; 5 had CSF pressure measurements. CMS subjects had lower SpO2,higher Hb, higher brain blood density, lower mean cerebral blood flow (CBF), and significant cerebral circulatory delay compared to controls. The nine CMS subjects with neurological deterioration showed diffuse cerebral edema on imaging and more deranged cerebral hemodynamics. CSF pressure was elevated in those with edema. We conclude that cerebral edema, a previously unrecognized complication, may develop in CMS patients and cause encephalopathy. Contributing factors appear to be exaggerated polycythemia and hypoxemia, and lower and sluggish CBF compared to CMS patients without cerebral edema; but what triggers this complication is unknown. Recognition and treatment of this serious complication will help reduce morbidity and mortality from CMS.
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Haihua
authors.initials: H
authors.lastname: Bao
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Duoyao
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Xipeng
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Youshen
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Guixiu
authors.initials: G
authors.lastname: Yin
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Meng
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Ma
authors.affiliation: Institute for Altitude Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Telluride, CO, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Hackett
authors.affiliation: Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.|Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China.
authors.forename: Ri-Li
authors.initials: RL
authors.lastname: Ge
mesh_terms: D000328:Adult; D000532:Altitude Sickness / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D001929:Brain Edema / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged