Cervical artery dissection at high altitude: an overview of two patients

Bhattarai, Shreeyukta; Elson, William H.; Pradhan, Rashila; Pandey, Prativa

doi:10.1093/jtm/taw067

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…A recent report described two mountain climbers who developed acute onset of neck pain with symptoms similar to our patients, and their subsequent workup revealed spontaneous carotid artery dissection. 6 Although high altitude or mountain travel is not a known risk for carotid artery dissection, studies have identified altered cerebral blood flow dynamics at high altitude and endothelial dysfunction in response to hypoxia. 7 We postulate that the altered cerebral blood flow triggered by the high altitude with resultant endothelial dysfunction may have played a role in the development of carotidynia in our patients.…”

Section: Discussionmentioning

confidence: 99%

Carotidynia in high-altitude travelers

2017

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Background Carotidynia is characterized by focal pain and tenderness of the carotid artery without associated hemodynamic or structural abnormalities. Carotid artery pathology has also been known to occur in high altitude due to aberrant baroreceptor response in the carotid bulb. Case Presentation We herein report two cases of high altitude-related idiopathic carotidynia. The first patient was a geologist who performed oil reserve survey in the Alaska Mountain, while the second patient was hiking in a mountain trail in Peru. Both patients developed acute onset of neck pain while traveling in high-altitude mountainous ranges. Carotid imaging showed transmural inflammation surrounding the carotid artery without intraluminal stenosis. Treatment with low-dose aspirin and nonsteroidal anti-inflammatory drug were initiated, which resulted in complete resolution of their symptom. Follow-up carotid ultrasound showed complete resolution of carotid inflammatory tissue density. Discussion This represents the first report linking carotidynia to high-altitude traveling.

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Section: Discussionmentioning

confidence: 99%

Carotidynia in high-altitude travelers

2017

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“…Moreover, several investigators suggested a potential impact of high altitude exposure on preexisting neurological conditions, and some of these disturbances falling outside the umbrella of altitude sickness have been documented in both case reports and reviews. These abnormalities included: migraine and other headaches, epileptic seizures, MS, permanent/transient ischemia of the brain, intracranial hemorrhage and vascular malformations, occlusive cerebral artery disease, cerebral venous thrombosis, intracranial space-occupying lesions, dementia, extrapyramidal disorders [154], cervical artery dissection, nystagmus, third and fifth cranial nerve palsies, eyelid ptosis, nystagmus [155], sixth nerve palsy, epilepsy [156], various ocular disturbances [157], retinopathy in otherwise healthy individuals [158], visual blurring, tinnitus, dysarthria, speech arrest, facial dysesthesia, generalized seizure, right-sided hemiparesis, ataxia, dizziness [159], and even meningioma [160]. Moreover, there was also reported a positive family history on epileptic disorders in father, brother, and daughter of the high altitude patient who had no preceding symptoms of acute mountain sickness [156], and a personal and familial vascular history in a 34-year old women with neurological symptoms [159].…”

Section: A Possible Association Between High Altitude Climbing Freque...mentioning

confidence: 99%

Solving the New Puzzle(s) 2014-2022: Flammer Syndrome Probably Represents a Mild Endophenotype of Raynaud’s Phenomenon Mainly Associated with Ocular Disturbances and Also Due to Latent T. gondii Infection

Prandota¹

2023

J Clin Med Cur Res

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negative effect on quality of life [9]. The study of 334 healthy subjects aged 50 years or elder in Japan showed that proportion of participants with increased sensitivity to cold widely ranged (6.1%-30.8% men, 14.3%-28.3% women) [12].In Eastern Asian populations CHHF occurs in 20%-52% of subjects [13][14][15], and ratio of men to women is 2:3 [16]. In Japan, this condition called "hiesho" is quite common involving over 60% of females, and in the latter stage of pregnancy "hiesho" manifests in about 40% of women, particularly in the advanced maternal age [17,18]. One study comparing Japanese with Brazilians reported that 57% of Brazilian pregnant women were aware of cold sensations [19,20]. CHHF is associated also with RP, gastric disturbances [21], as well as gynecological disorders, such as infertility and dysmenorrhea [22,23]. Nb. T. gondii infection causes ovarian dysfunction and disturbances in sperm motility, viability and concentration values, epididymis weight, and testicle inflammation [24][25][26][27][28].The presence of "hiesho" was found to be risk factor which can also lead to abnormal delivery because of weak labor pains, prolonged labor and atonic bleeding, premature delivery, amnion membrane rupture [17,29,30].In this context, it should be added that traditional Japanese fish dishes sushi and sashimi may, at least in part, play a role in development of these disorders [31], especially that wide distribution of T. gondii amongst sea fish and mammals may affect human health worldwide (e.g. the highest prevalence of the pathogen was found in otter (54.8%), and dolphin, whale and porpoise (30.92%) [32]. B. FS heritability.In Europe, most of FS symptoms appear in puberty and alleviate along with age, in women after menopause begun [33], albeit in the study of 3067 persons aged 65 years or elder 23.6% men and 28.6% women had cold extremities [34]. Importantly, parents of FS subjects also had similar symptoms which may suggest a heritability of this clinical entity [3,4]. Moreover, Konieczka & Erb [4] noted that there is a relationship between FS and RP, and suggested a genetic background of RP [35][36][37][38], but they believed that additional factor(s) may also play a role [4,35]. Nb. genetic factors appeared to be important in the development of RP as has been demonstrated in one familial and twin study [39]. FS often occurs in individuals who are slender, have a low blood pressure, are active, but also have unusually cold extremities, increased pain sensitivity, altered circadian rhythm, and prolonged falling asleep time [40,41]. C. Pathophysiological changes in FS.Individuals with FS have the autonomic nervous system imbalance with sympathetic predominance [4,42], lymphocytes and leukocytes in the eye have altered gene expression, and activated astrocytes in the retina also change their gene expression and morphology [2,[43][44][45], slightly increased plasma endothelin-1 (ET-1) levels, and increased systemic oxidative stress [5,46]. They also have enhanced sensitivity to some drugs, such as for ...

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