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Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia.

Abstract

A 36-year-old woman with no medical history participated in a trekking in Ladakh up to 5300 m of altitude. She was well acclimatized and presented no previous sign of acute mountain sickness, high altitude pulmonary edema or high altitude cerebral edema. After an intense effort to catch up with her group, she became breathless and complained of visual disturbances, fatigue, dizziness, and confusion. During her descent to a lower altitude (4800 m), with the help of companions, she lost consciousness several times. After a 14-hour sleep, she recovered and all symptoms disappeared so that she was able to walk along with the group for 20 km. On returning home, she went through a battery of examinations that were all normal: cerebral magnetic resonance imaging, Doppler of supra-aortic arteries, 24 hours Holter, and cardiac transthoracic and transesophageal echography. A hypoxia exercise test revealed a hyper-response to hypoxia with severe hypocapnia. The etiology of this neurological episode is discussed (transient embolic ischemic attack, migraine, cerebral edema, and global amnesia). The patchy distribution of neurological symptoms is not in favor of a thrombotic event. The most probable diagnosis proposed is a transient cerebral ischemia due to local cerebral vasoconstriction related to hyperventilation-induced hypocapnia in a context of acute severe exercise. Special attention should be given to subjects who show a hyper-responsiveness to hypoxia before a sojourn at high altitude: they should avoid unnecessary hyperventilation due to any kind of stress, emotion, or exhaustive exercise.

Authors+Show Affiliations

INSERM U1272 Hypoxie et Poumon, Université Paris 13, Bobigny, France. Association pour la Recherche en Physiologie de l'Environnement, Bobigny, France. Institut National du Sport, de l'Expertise et de la Performance, Pôle médical, Paris, France.Association pour la Recherche en Physiologie de l'Environnement, Bobigny, France.Assistance Publique-Hôpitaux de Paris, Hôpital Jean-Verdier, Service de Physiologie et Explorations Fonctionnelles, Bondy, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31971870

Citation

Richalet, Jean-Paul, et al. "Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia." High Altitude Medicine & Biology, 2020.
Richalet JP, Larmignat P, Poignard P. Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia. High Alt Med Biol. 2020.
Richalet, J. P., Larmignat, P., & Poignard, P. (2020). Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia. High Altitude Medicine & Biology, doi:10.1089/ham.2019.0100.
Richalet JP, Larmignat P, Poignard P. Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia. High Alt Med Biol. 2020 Jan 22; PubMed PMID: 31971870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transient Cerebral Ischemia at High Altitude and Hyper-Responsiveness to Hypoxia. AU - Richalet,Jean-Paul, AU - Larmignat,Philippe, AU - Poignard,Patricia, Y1 - 2020/01/22/ PY - 2020/1/24/entrez PY - 2020/1/24/pubmed PY - 2020/1/24/medline KW - altitude KW - hyperventilation KW - hypocania KW - neurological disorder JF - High altitude medicine & biology JO - High Alt. Med. Biol. N2 - A 36-year-old woman with no medical history participated in a trekking in Ladakh up to 5300 m of altitude. She was well acclimatized and presented no previous sign of acute mountain sickness, high altitude pulmonary edema or high altitude cerebral edema. After an intense effort to catch up with her group, she became breathless and complained of visual disturbances, fatigue, dizziness, and confusion. During her descent to a lower altitude (4800 m), with the help of companions, she lost consciousness several times. After a 14-hour sleep, she recovered and all symptoms disappeared so that she was able to walk along with the group for 20 km. On returning home, she went through a battery of examinations that were all normal: cerebral magnetic resonance imaging, Doppler of supra-aortic arteries, 24 hours Holter, and cardiac transthoracic and transesophageal echography. A hypoxia exercise test revealed a hyper-response to hypoxia with severe hypocapnia. The etiology of this neurological episode is discussed (transient embolic ischemic attack, migraine, cerebral edema, and global amnesia). The patchy distribution of neurological symptoms is not in favor of a thrombotic event. The most probable diagnosis proposed is a transient cerebral ischemia due to local cerebral vasoconstriction related to hyperventilation-induced hypocapnia in a context of acute severe exercise. Special attention should be given to subjects who show a hyper-responsiveness to hypoxia before a sojourn at high altitude: they should avoid unnecessary hyperventilation due to any kind of stress, emotion, or exhaustive exercise. SN - 1557-8682 UR - https://www.unboundmedicine.com/medline/citation/31971870/Transient_Cerebral_Ischemia_at_High_Altitude_and_Hyper-Responsiveness_to_Hypoxia L2 - https://www.liebertpub.com/doi/full/10.1089/ham.2019.0100?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -