Rare case of cerebral stroke &amp; venous thrombosis developed during high altitude expedition

Prabhakar, A; Aggarwal, Meenakshi; Khurana, Poonam; Trehan, Naresh

doi:10.4103/0971-3026.29004

Cited by 3 publications

(3 citation statements)

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“…Apart from historical accounts of thrombotic events in Himalayan trekkers documented some 30 years ago, 4 case reports of high altitude venous thrombosis in athletes and fitness enthusiasts are limited to two climbers 5,6 an instructor training at simulated high altitude 7 and a Himalayan mountaineer. 8 Large-scale hematological studies [9][10][11][12] and more specific accounts of high altitude thrombosis in physically active people have tended to focus on military personnel (eg, cerebral venous thrombosis in serving soldiers 13 ) and not athletes and/or active people, per se. This is significant because altitude training regimens are often used by lowland competition athletes to improve their sea level performance and because the popularity of high altitude, winter sports, and explorations (eg, the Kilimanjaro Challenge, alpine ascents, and extreme expeditions) continues to grow.…”

Section: Discussionmentioning

confidence: 99%

Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude

Hull

Rajendran

Barnes³

2016

Wilderness & Environmental Medicine

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High intensity exercise is associated with several potentially thrombogenic risk factors, including dehydration and hemoconcentration, vascular trauma, musculoskeletal injuries, inflammation, long-distance travel, and contraceptive usage. These are well documented in case reports of venous thrombosis in track and field athletes. For mountaineers and those working at high altitude, additional risks exist. However, despite there being a high degree of vigilance for "classic" conditions encountered at altitude (eg, acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema), mainstream awareness regarding thrombotic conditions and their complications in mountain athletes is relatively low. This is significant because thromboembolic events (including deep vein thrombosis, pulmonary embolism, and cerebral vascular thrombosis) are not uncommon at altitude. We describe a case of deep vein thrombosis and pulmonary embolism in a male mountain guide and discuss the diagnostic issues encountered by his medical practitioners. Potential risk factors affecting blood circulation (eg, seated car travel and compression of popliteal vein) and blood hypercoagulability (eg, hypoxia, environmental and psychological stressors [avalanche risk, extreme cold]) relevant to the subject of this report and mountain athletes in general are identified. Considerations for mitigating and managing thrombosis in addition to personalized care planning at altitude are discussed. The prevalence of thrombosis in mountain athletes is uncharted, but lowlanders increasingly go to high altitude to trek, ski, or climb. Blood clots can and do occur in physically active people, and thrombosis prevention and recognition will demand heightened awareness among participants, healthcare practitioners, and the altitude sport/leisure industry at large.

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Section: Discussionmentioning

confidence: 99%

Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude

Hull

Rajendran

Barnes³

2016

Wilderness & Environmental Medicine

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“…The physiological response to hypobaric hypoxia found at high altitude stimulates polycythaemia, initially as a result of decreased plasma volume and subsequently as a result of increased production of erythropoietin, which in turn leads to increased red blood cell production and a subsequent raised haematocrit and haemoglobin 6. Polycythaemia is known to be a risk factor for venous thromboembolism 4 7 8. It is known that there is an increased incidence of deep venous thrombosis (DVT) and pulmonary emboli (PE) at high altitude, although it is difficult to know how much is directly attributable to altitude and how much due to other variables such as dehydration, exercise or immobility 6.…”

Section: Discussionmentioning

confidence: 99%

Sudden onset hemiplegia at high altitude

Chandler¹,

Mellor

2015

J R Army Med Corps

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Travel to high altitude and the incumbent exposure to hypobaric hypoxia leads to a prothrombotic state. This may increase the likelihood of thromboembolic events, including stroke, in otherwise healthy individuals. While there have been sporadic anecdotal reports of 'stroke-like' syndromes at high altitude for over 100 years, there are surprisingly few detailed reports supported by imaging.This report describes a case of posterior circulation infarct thought to be due to a paradoxical embolus through a patent foramen ovale. The relationship between high-altitude physiology, increased incidence of thromboembolism and the significance of patent foramen are discussed in the report.

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“…11,12 CVST is sometimes associated with stroke, the possibility of which appears remote in this case, although it cannot be excluded. 13 CVST at altitude has also been described with pre-existing risk factors, which were excluded in this case through a review of the casualty's medical records. CVST can cascade in the setting of polycythemia, haemoconcentration, dehydration, vascular spasms, and cerebral circulatory disturbance produced by comorbid HACE.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis Masquerading as High Altitude Cerebral Edema at Extreme Altitude

Khan

2016

ijtmgh

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Rare case of cerebral stroke & venous thrombosis developed during high altitude expedition

Cited by 3 publications

References 0 publications

Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude

Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude

Sudden onset hemiplegia at high altitude

Cerebral Venous Sinus Thrombosis Masquerading as High Altitude Cerebral Edema at Extreme Altitude

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