Neurologic Syndromes of High Altitude

Until recently, most neurologic events at high altitude were attributed to HACE or AMS. Clearly, this has been a diagnostic oversimplification. Other syndromes now recognized as related to high altitude include altitude syncope, cerebrovascular spasm (migraine equivalent), cerebral arterial or venous thrombosis (infarct), transient ischemic attack, and cerebral hemorrhage. These syndromes are characterized by more focal neurologic findings than in cerebral edema, though differentiation in the field may be impossible.

Other problems may be due to exacerbation or unmasking of underlying disease, such as previously asymptomatic brain tumors and epilepsy. Presumably, space-occupying lesions become symptomatic because of increased brain volume at altitude. Hyperventilation (hypocapnic alkalosis), which is commonly used to induce seizure activity on electroencephalography, may explain unmasking of a seizure disorder at altitude, while changes in cerebral blood flow may exacerbate vascular lesions.

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