Stroke at High Altitude in an Experienced Sherpa Climber: A Case Report

Sherpa, Mingma T.; Shrestha, Raksha

doi:10.1089/ham.2020.0157

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…At high altitude, other risk factors might also increase as elevation is gained. At high altitude, physical activity is reduced due to harsh conditions, reducing mobilization, and increasing hyperventilation ( Sherpa and Shrestha, 2020 ; Uno et al, 2020 ). Dehydration aggravating blood stasis, hyperventilation aggravating dehydration and a proposed increased platelet adhesiveness might counteract some of the protective effects related to a reduced stroke incidence found at moderate or high altitude ( Sharma et al, 1980 ; Tyagi et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

et al. 2021

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Introduction: Worldwide, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analyses suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates.Methods: An ecological analysis of all stroke hospital admissions, mortality rates, and disability-adjusted life years in Ecuador was performed from 2001 to 2017. The cases and population at risk were categorized in low (<1,500 m), moderate (1,500–2,500 m), high (2,500–3,500 m), and very high altitude (3,500–5,500 m) according to the place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated.Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.

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Section: Discussionmentioning

confidence: 99%

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

et al. 2021

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“…51 Recently was published a case of stroke occurred in a 44-year-old experienced Sherpas climber who resides at HA (3800 m). 52 On the contrary, few epidemiological surveys conducted at different altitude suggested that cerebrovascular disease may be less frequent than at sea level. Razdan et al 53 performed the survey in the Kashmir region of South India (1530 m) among rural population.…”

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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“…The results of this study are close to their test results. At the same time, the study found that the carotid plaque detection rate (57.14%) significantly higher than altitude patients (39.90%), analysis of the reason and high altitude low oxygen environment can cause the total hemoglobin, lipid metabolism and blood pressure level changes, increase the risk of small thrombosis, thus aggravate the stroke atherosclerosis degree of [15].…”

Section: Discussionmentioning

confidence: 87%

Relationship between carotid plaque and plasma Hcy, hs-CRP and RBC in stroke patients at different elevations

Tian,

Liu,

Zhang

2023

Preprint

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Relationship between carotid plaque and plasma Hcy, hs-CRP and RBC in stroke patients at different elevations Abstract：Objective To explore the relationship of carotid plaque with plasma homocysteine (Hcy), high-sensitive C-reactive protein (hs-CRP) and red blood cell count (RBC) in stroke patients at different elevations. Methods Selecting patients with cerebral infarction at different altitudes as screening subjects, RBC and carotid media thickness (IMT) of two groups of patients were measured.Results The total detection rate was 48.52% (197/403), with a detection rate of 57.14% (116/203) in Group A and 39.9% (81/203) in Group B. The detection rate in Group A was significantly higher than that in Group B (P<0.05). Group A had higher total cholesterol (TC), Hcy, hs-CRP, RBC, and IMT, while high-density lipoprotein cholesterol (HDL-C) was lower (P<0.05). Groups A and B without plaques and HDL-C had higher Hcy, LDL-C, RBC, and IMT (P<0.05); The levels of Hcy, hs-CRP, and RBC in stable plaques were lower (P<0.05), while the levels of Hcy, hs-CRP, and RBC in vulnerable plaques in Group A were higher than those in Group B (P<0.05). Conclusion The detection rate of carotid plaque was high in stroke patients at high altitude, Hcy, hs-CRP and RBC are all independent risk factors for carotid plaque in stroke patients in high altitude areas.

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Stroke at High Altitude in an Experienced Sherpa Climber: A Case Report

Cited by 4 publications

References 8 publications

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

Recommendations for traveling to altitude with neurological disorders

Relationship between carotid plaque and plasma Hcy, hs-CRP and RBC in stroke patients at different elevations

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