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The cerebral venous system and anatomical predisposition to high altitude headache
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(2013) The cerebral venous system and anatomical predisposition to high altitude headache. Annals of Neurology, Volume 73 (Number 3). pp. 381-389. doi:10.1002/ana.23796 ISSN 0364-5134.
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Official URL: http://dx.doi.org/10.1002/ana.23796
Abstract
Abstract
Objective:
As inspired oxygen availability falls with ascent to altitude, some individuals develop ‘high altitude headache’ (HAH). We postulated that HAH results when hypoxia-associated increases in cerebral blood flow occur in the context of restricted venous drainage, and is worsened when cerebral compliance is reduced. We explored this hypothesis in three studies.
Methods:
High Altitude Studies: Retinal venous distension (RVD) was opthalmoscopically-assessed in 24 (6 female) and sea-levelcranial Magnetic Resonance Imaging performed in12 subjects ascending to 5300m. Correlation of headache burden (summed severity scores [0-4] ≤24 hours from arrival at each altitude) with RVD, and with cerebral/CSF/venous compartment volumes was sought.
Sea-Level Hypoxic Study: Eleven subjects underwent Gadolinium-enhanced Magnetic Resonance Venography before and during hypoxic challenge (FiO2 0.11, 1 hour).
Results:
High Altitude Study: Headache burden correlated with both RVD (Spearman's rho 0.55, p=0.005), and with the degree of narrowing of one or both transverse venous sinuses (r -0.56 p=0.03). It also related inversely to both the lateral+third ventricle summed volumes (Spearman's Rho -0.5, p=0.05) and peri-cerebellar CSF volume (r-0.56, p=0.03). Hypoxic Study: Cerebral and retinal vein engorgement were correlated, and rose as Combined Conduit Score fell (a measure of venous outflow restriction: r=-0.66, p<0.05 and r=-0.75, p<0.05 respectively).
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Annals of Neurology | ||||
| Publisher: | John Wiley & Sons, Inc. | ||||
| ISSN: | 0364-5134 | ||||
| Official Date: | 2013 | ||||
| Dates: |
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| Volume: | Volume 73 | ||||
| Number: | Number 3 | ||||
| Page Range: | pp. 381-389 | ||||
| DOI: | 10.1002/ana.23796 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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