Bilateral ischemia of the insular cortex after high altitude climbing: A case report

D’Arrigo, Antonello; Altavilla, Riccardo; Bartesaghi, Francesca; Floro, Stefano; Campiglio, Laura; Secchi, Manuela; Priori, Alberto

doi:10.1016/j.jocn.2019.05.049

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…Several authors have reported ischemic stroke cases with the acute HA exposure in healthy subjects without any known risk factors (>4500 and 3600 m, respectively). 58 , 59 In the presence of deep vein thrombosis, a cryptogenic stroke due to a paradoxical embolism should be considered as a consequence of the increased pulmonary vascular resistance and arterial pressure due to the hypoxic vasoconstriction at HA which increased the likelihood of right to left shunting in those with a patent foramen ovale (30% healthy population). Indeed, embolic etiology was suspected in cases reported in the literature due to the presence of a large patent foramen ovale (3840 m).…”

Section: Literature and Research Methodsmentioning

confidence: 99%

Recommendations for traveling to altitude with neurological disorders

Falla

Giardini²,

Angelini

2021

J Cent Nerv Syst Dis

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Background Several neurological conditions might worsen with the exposure to high altitude (HA). The aim of this review was to summarize the available knowledge on the neurological HA illnesses and the risk for people with neurological disorders to attend HA locations. Methods A search of literature was conducted for several neurological disorders in PubMed and other databases since 1970. The neurological conditions searched were migraine, different cerebrovascular disease, intracranial space occupying mass, multiple sclerosis, peripheral neuropathies, neuromuscular disorders, epileptic seizures, delirium, dementia, and Parkinson’s disease (PD). Results Attempts were made to classify the risk posed by each condition and to provide recommendations regarding medical evaluation and advice for or against traveling to altitude. Individual cases should be advised after careful examination and risk evaluation performed either in an outpatient mountain medicine service or by a physician with knowledge of HA risks. Preliminary diagnostic methods and anticipation of neurological complications are needed. Conclusions Our recommendations suggest absolute contraindications to HA exposure for the following neurological conditions: (1) Unstable conditions–such as recent strokes, (2) Diabetic neuropathy, (3) Transient ischemic attack in the last month, (4) Brain tumors, and 5. Neuromuscular disorders with a decrease of forced vital capacity >60%. We consider the following relative contraindications where decision has to be made case by case: (1) Epilepsy based on recurrence of seizure and stabilization with the therapy, (2) PD (± obstructive sleep apnea syndrome-OSAS), (3) Mild Cognitive Impairment (± OSAS), and (4) Patent foramen ovale and migraine have to be considered risk factors for acute mountain sickness.

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Section: Literature and Research Methodsmentioning

confidence: 99%

Recommendations for traveling to altitude with neurological disorders

Falla

Giardini²,

Angelini

2021

J Cent Nerv Syst Dis

View full text Add to dashboard Cite

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“…Regional GM changes were seen in the mountain climbers who repeated expeditions to Mount Everest ( Di Paola et al, 2008 ), adult soldiers who had garrisoned the frontiers in the Qinghai-Tibet Plateau for 2 years ( Zhang et al, 2013b ), climbers who made a single ascent to for less than 36 h ( D’Arrigo et al, 2019 ), and college freshmen who immigrated to the Qinghai-Tibet Plateau and were followed-up for 2 years ( Chen X. et al, 2017 , Chen et al, 2019a ). To explore the influences of the environment on HA residents, Han immigrant adolescents ( Zhang et al, 2010 ) and HA adolescents ( Yan et al, 2010 ; Wei et al, 2017 ) living in the Qinghai-Tibet Plateau were studied, and decreased GM volume and changes in cortical thickness were detected.…”

Section: Brain Structures At High Altitudementioning

confidence: 99%

“… Changed structure and function in insular cortex in HA population. (A) The decreased cortical thickness in sea-level college students who had a 30-day teaching at HA ( Fan et al, 2016 ); (B) hyperintense signaling in a woman after a rapid ascent to mountain ( D’Arrigo et al, 2019 ); (C) the decreased sulcus depth ( Wei et al, 2017 ) (a) and decreased cerebral blood flow ( Wang et al, 2018 ) (b) in HA Tibetan natives; (D) the decreased gray matter volume ( Zhang et al, 2010 ) (a) and longer dwelay of hemodynamic response ( Yan et al, 2011b ) (b) in the descendants of Han population who have immigrated to HA for several generations; (E) the increased gray matter volume in Tibetan adolescents descending to sea level for 4 years ( Zhang et al, 2013a ); (F) the decreased ALFF in soldiers who had garrisoned the frontiers at HA for 2 years ( Zhang et al, 2017 ). The arrow indicates the insular cortex.…”

Section: Conclusion Of the Findings In Brain Structures And Functionsmentioning

confidence: 99%

The human brain in a high altitude natural environment: A review

Zhang

2022

Front. Hum. Neurosci.

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With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.

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Bilateral ischemia of the insular cortex after high altitude climbing: A case report

Cited by 2 publications

References 4 publications

Recommendations for traveling to altitude with neurological disorders

Recommendations for traveling to altitude with neurological disorders

The human brain in a high altitude natural environment: A review

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