Cerebrovascular Syndromes of Altitude

Strokes, due both to infarct and hemorrhage in the arterial circulation, as well as venous thrombosis have been reported in young healthy persons at altitude who otherwise would not be considered at risk for such conditions. Transient ischemic attack, cortical blindness, and various focal neurologic signs, such as hemiparesis or hemiplegia of a transient nature, also occur. Because these latter events are reversible, they suggest etiologies such as vasospasm, watershed hypoxia between arterial zones, or transient ischemic attack.

Differentiation of the various neurologic syndromes may be impossible in the field, and treating as if cerebral edema were present may be reasonable, with a rapid descent to lower altitude, oxygen, and steroids, and evacuation to a hospital if symptoms persist despite treatment. Fortunately, focal neurologic signs usually resolve spontaneously and do not recur upon reascent. However, a thorough cerebrovascular evaluation before advising reascent may be prudent.

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