Sudden onset hemiplegia at high altitude

Chandler, Henry C; Mellor, Adrian

doi:10.1136/jramc-2014-000372

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…The presence of PFO could make this population even susceptible to these environmental challenges. In fact, studies have shown that people with PFO in high altitude environment fail to increase their pulmonary gas exchange efficiency, potentially due to the right to left intracardiac shunt [ 24 ], and the hypoxia condition leads to prothrombotic state and pulmonary hypertension [ 25 ], which could lead to more paradoxical embolism formation [ 26 ]. All these risk factors set a non-suitable condition for people with PFO, making them easier to develop brain ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

The correlation between patent foramen ovale and brain ischemia in plateau residents

Liu

Feng

et al. 2021

BMC Cardiovasc Disord

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Background It has been suggested that patent foramen ovale (PFO) contributes to the majority of cryptogenic stroke cases in young people, however, the direct link is still undetermined. Here we analyzed the correlation between PFO and brain ischemia lesions in a cohort of cases that were long-term residents in the plateau to provide solid evidence to support the causal relation between PFO and brain ischemia lesion or cryptogenic stroke. Methods Long-term residents with young age from Qinghai Plateau were recruited and separated by PFO positivity. Brain MRI was used to image 100 PFO positive cases and 100 healthy controls. The diameter of PFO was measured by echocardiography. The location, number and anterior/posterior circulation of ischemia lesions were also evaluated. The correlation between PFO (including positivity and diameter) and brain ischemia lesion (including positivity and other characteristics) was analyzed by chi-square test. Further, the chi-square test for the trend test was used to analyze the linear correlation between these groups. Results We found a strong correlation between the positivity of PFO and brain ischemia lesion, with 71% of PFO cases showing the presence of brain ischemia lesions, and only 19% for healthy controls (p < 0.001). The diameter of PFO is strongly and linearly correlated with the incidence rate of brain ischemia lesion (RR = 3.737 (95%CI 2.496 to 5.767). Conclusion We found a convincing correlation between the positivity of PFO and brain ischemia lesion in residents of the plateau. Our findings provide another solid evidence of the direct causal relation between PFO and brain ischemia lesion.

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Section: Discussionmentioning

confidence: 99%

The correlation between patent foramen ovale and brain ischemia in plateau residents

Liu

Feng

et al. 2021

BMC Cardiovasc Disord

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“…These search terms revealed 236 citations. After identifying relevant articles that discussed stroke at high altitude, and cross referencing, we found one review (Ortiz-Prado and Dunn, 2011), eight case series (including pooled analysis) (Razdan et al, 1989;Jaillard et al, 1995;al Tahan et al, 1998;Jha et al, 2002;Niaz and Nayyar, 2003;Mahajan et al, 2004;Dhiman et al, 2018;Zhang et al, 2020), and seven case reports (Murdoch, 1995;Dietz and McKiel, 2000;Bandyopadhyay et al, 2002;Wilson et al, 2011;Chan et al, 2012;Yanamandra et al, 2014;Chandler and Mellor, 2016) that were considered appropriate for this review. Of the eight case series, four were from high altitude, including a pooled analysis (more than 2,500 m) ( Jaillard et al, 1995;Jha et al, 2002;Niaz and Nayyar, 2003;Zhang et al, 2020), and four were from moderate altitude (1,500-2,500 m) (Razdan et al, 1989;al Tahan et al, 1998;Mahajan et al, 2004;Dhiman et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

“…This increase was found particularly in younger age, mostly between 20 and 45 years. The stroke rates were found to be 10 times (Niaz and Nayyar, 2003) to 13 times (Razdan et al, 1989;Jaillard et al, 1995;al Tahan et al, 1998;Dietz and McKiel, 2000;Anand et al, 2001;Bandyopadhyay et al, 2002;Jha et al, 2002;Mahajan et al, 2004;Wilson et al, 2011;Chan et al, 2012;Yanamandra et al, 2014;Murdoch, 2015;Chandler and Mellor, 2016;Dhiman et al, 2018;Zhang et al, 2020) higher among people living at very high altitude and extremely high altitude.…”

Section: Epidemiology Of Stroke At High Altitudementioning

confidence: 98%

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Stroke at Moderate and High Altitude

Syed

Khatri

Alamgir

et al. 2022

High Altitude Medicine & Biology

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Background: Stroke at high altitude is an understudied area in stroke research. With improvements in road infrastructure, access to high-altitude areas for recreation and living purposes has risen. Subsequently, it has been anticipated that due to normal physiological changes to high altitude the incidence of stroke is also likely to increase in these regions. Methods: We searched PubMed for available literature about stroke at high altitude. Cross-referencing was done from available articles and through other scientific search engines. Relevant case series and case reports were included in this review of the topic. Results: Only one review article, eight case series (including review of literature), and seven case reports were identified that could be included in this review. Most of the available data come from moderate and high altitude.Conclusions: There is limited available literature about stroke at high and extreme altitudes. Stroke at high altitude is likely to become an important subset of stroke population. Currently, there is inadequate knowledge about the incidence and prevalence, mechanisms, and stroke outcomes. Cerebral venous thrombosis is more common than arterial stroke. Stroke is probably secondary to conventional risk factors, polycythemia, and other coagulopathies. A case-control study may identify the at-risk population for stroke at moderate and high altitudes.

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CT assessment of the increased density of cerebral vessels in plateau region

Zhou

Tsering²,

Zhao

et al. 2021

Sci Rep

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In this study, the relationship between the brain parenchymal density, the cerebral vessel density, the mean corpuscular hemoglobin (MCH) content, the mean corpuscular hemoglobin concentration (MCHC), and the morbidity associated with lacunar infarction of residents living in either the plains or the plateau regions were analyzed and compared for their potential clinical implications. Clinical data from the brain CT scans of individuals living in either the plain or plateau regions (129 each) were collected. Specifically, the CT values for basal ganglia, the middle cerebral artery, and the superior sagittal sinus, along with the number of patients with lacunar infarction, were collected. In addition, the MCH and MCHC values were measured in blood samples collected within 48 h following the CT scans. For statistical analysis, an independent sample t-test, Pearson's correlation test (permutation test), and Chi-squared test were employed. The inhabitants of the plateau had a significantly higher CT value of basal ganglia, the middle cerebral artery, and superior sagittal sinus and also higher levels of MCH and MCHC in the blood (ps < 0.001) than the inhabitants of the plains region. Further, there was a significant positive correlation between the three aforementioned CT values and the MCH and MCHC findings. However, no significant differences were found in the morbidity of lacunar infarction between these two regions (p > 0.05). The inhabitants in the plateau have a significantly higher brain parenchymal density, higher CT value for cerebral vessels density, and higher blood MCH and MCHC levels in comparison with individuals occupying the plains. Concurrently, the parenchymal density and the CT values are shown to be positively correlated with the MCH and MCHC content in the blood.

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Sudden onset hemiplegia at high altitude

Cited by 4 publications

References 7 publications

The correlation between patent foramen ovale and brain ischemia in plateau residents

The correlation between patent foramen ovale and brain ischemia in plateau residents

Stroke at Moderate and High Altitude

CT assessment of the increased density of cerebral vessels in plateau region

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