Sagoo, Ravjit S., Hutchinson, Charles E., Wright, Alex, Handford, Charles, Parsons, Helen, Sherwood, Victoria, Wayte, Sarah C. , Nagarajaan, Sanjoy, NgAndwe, Eddie, Wilson, Mark H. and Imray, C. (Chris) (2017) Magnetic resonance investigation into the mechanisms involved in the development of high-altitude cerebral edema. Journal of Cerebral Blood Flow & Metabolism, 37 (1). pp. 319-331. doi:10.1177/0271678X15625350 ISSN 0271-678X.

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Abstract

Rapid ascent to high altitude commonly results in acute mountain sickness, and on occasion potentially fatal high-altitude cerebral edema. The exact pathophysiological mechanisms behind these syndromes remain to be determined. We report a study in which 12 subjects were exposed to a FiO2 = 0.12 for 22 h and underwent serial magnetic resonance imaging sequences to enable measurement of middle cerebral artery velocity, flow and diameter, and brain parenchymal, cerebrospinal fluid and cerebral venous volumes. Ten subjects completed 22 h and most developed symptoms of acute mountain sickness (mean Lake Louise Score 5.4; p < 0.001 vs. baseline). Cerebral oxygen delivery was maintained by an increase in middle cerebral artery velocity and diameter (first 6 h). There appeared to be venocompression at the level of the small, deep cerebral veins (116 cm3 at 2 h to 97 cm3 at 22 h; p < 0.05). Brain white matter volume increased over the 22-h period (574 ml to 587 ml; p < 0.001) and correlated with cumulative Lake Louise scores at 22 h (p < 0.05). We conclude that cerebral oxygen delivery was maintained by increased arterial inflow and this preceded the development of cerebral edema. Venous outflow restriction appeared to play a contributory role in the formation of cerebral edema, a novel feature that has not been observed previously.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Cancer Research Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Mountain sickness, Altitude, Influence of, Mountaineering --Health aspects, Brain -- Physiology, Cerebral edema, Adaptation (Physiology), Mountaineering -- Physiological aspects, Acclimatization
Journal or Publication Title:	Journal of Cerebral Blood Flow & Metabolism
Publisher:	Nature Publishing Group
ISSN:	0271-678X
Official Date:	1 January 2017
Dates:	Date Event 1 January 2017 Published 8 January 2016 Available 27 November 2015 Accepted 10 August 2015 Submitted
Volume:	37
Number:	1
Page Range:	pp. 319-331
DOI:	10.1177/0271678X15625350
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	11 January 2016
Date of first compliant Open Access:	12 January 2016

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