Ataxia: An Early Indicator in High Altitude Cerebral Edema

Abstract

Wu, Tianyi, Shouquan Ding, Jinliang Liu, Jianhou Jia, Ruichen Dai, Baozhu Liang, Jizhui Zhao, and Detang Qi. Ataxia: an early indicator in high altitude cerebral edema. High Alt. Med. Biol. 7:275-280, 2006.--As a result of industrial development in the western region of China, in 2001 the Chinese government decided to build Qinghai-Tibetan Railway. The new railroad stretches 1118 km from Golmud (2808 m) to Lhasa (3658 m), with more than three-quarter of the distance above 4000 m, through the Mt. Kun Lun and Tanggula ranges. From the beginning of the project on June, 29, 2001, to the end of the year of 2003, about 74,735 construction workers worked in the harsh climate, in adverse circumstances and a low-barometric-pressure environment. The construction provided an opportunity for the investigation and study of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). These altitude illnesses were very common in the construction workers. From July 1, 2001, to October 31, 2003, the overall incidence of AMS, HAPE, and HACE in the total workers was approximately 45%-95%, 0.49%, and 0.26%, respectively. Altitude illnesses were studied at two hospitals near the construction site. One hospital is located on the Fenghuoshan (Mt. Wind-gap) at an altitude of 4779 m (PB 428 torr), and the second hospital is situated in the Kekexili area at an altitude of 4505 m (PB 440 torr). Kekexili is a sparsely populated zone because the weather conditions are very bad all year round. These two hospitals received patients from the construction sites, where workers were working at altitudes between 4464 and 4905 m. A total of 8014 workers were treated at Fenghuoshan and 5488 were in Kekexili over the past 3 years. According to local guidance about proper medical care, workers ascending to high altitude should be examined physically, complete an AMS questionnaire, and be monitored for ataxia as an early warning sign of the impending, more serious aspects of HACE. The onset of HACE is frequently characterized by an ataxic gait, as reported since the middle of the 20th century (Gray et al., 1971; Wilson, 1973; Houston and Dickinson, 1975; Dickinson, 1979; Clarke, 1988; Hackett and Oelz, 1992; Hackett, 2002; Hackett and Roach, 2004). However, there are no detailed analyses of ataxia in HACE. This paper considers the relation between ataxia and HACE and its frequency, significance, and importance.

Sleep quality changes in insomniacs and non-insomniacs after acute altitude exposure and its relationship with acute mountain sickness

“…The prevalence of AMS has been shown in the literature to vary depending on the setting, from between 9% and 69% in the Alps23 to between 45% and 95% in Tibet 24. In our study, at 3,700 m, the prevalence of AMS in the insomnia group was 79.01%, 60.49%, and 32.10% on the first, third, and seventh days, respectively, which was significantly higher compared to prevalence in the non-insomnia group.…”

Acute high-altitude sickness

“…The leading signs of HACE are truncal ataxia and clouded consciousness. Absence of preceding or concurrent headache does not exclude the diagnosis of HACE [6]. Without appropriate treatment, HACE usually leads to death, sometimes within 24 h of onset.…”

Severe Acute Mountain Sickness and Suspected High Altitude Cerebral Edema Related to Nitroglycerin Use

“…"If the patient seems mildly drunk at altitude he has cerebral edema" (Clarke, 1988). In a case series of 66 patients with HACE, ataxia was present in 73% and altered consciousness in 79% (Wu et al, 2006). The mechanism of ataxia in HACE is still unclear; cerebellum seems to be particularly sensitive to high-altitude hypoxia.…”