Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

NEURORADIOLOGY
Year
: 2006  |  Volume : 16  |  Issue : 3  |  Page : 313--314

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


A Prabhakar, M Aggarwal, P Khurana, N Trehan 
 From the Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India

Correspondence Address:
A Prabhakar
Escorts Heart Institute And Research Centre, Okhla Road New Delhi - 110025
India




How to cite this article:
Prabhakar A, Aggarwal M, Khurana P, Trehan N. Rare case of cerebral stroke & venous thrombosis developed during high altitude expedition.Indian J Radiol Imaging 2006;16:313-314


How to cite this URL:
Prabhakar A, Aggarwal M, Khurana P, Trehan N. Rare case of cerebral stroke & venous thrombosis developed during high altitude expedition. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Aug 14 ];16:313-314
Available from: http://www.ijri.org/text.asp?2006/16/3/313/29004


Full Text

 INTRODUCTION



High Altitude pulmonary edema and cerebral edema are well known entities related to high altitude climbing. Cerebral sinus thrombosis and hemorrhage also develop as a consequence of dehydration. We present a case in which a mountaineer developed cerebral stroke and venous thrombosis at an altitude of about 5000 meters during an expedition to the Himalayas.

 CASE REPORT



A 56 year old male, with no known previous health problem went on an expedition to scale a place at 5500 meters in the Himalayas. On day 6 of his expedition at about 5000 meters he developed neurological dysfunction in the form of loss of equilibrium, progressive motor weakness, slurring of speech and diarrhea and later on day 12 at 4500 meters height he developed left sided hemiparesis and right sided facial nerve palsy. On day 15, he was airlifted to the nearest hospital given emergency medical care in the form of hyperbaric oxygen and then brought to our hospital.

Lab investigations revealed high haemoglobin concentration 19 gm% and hypo-protienemia 5.4 mg/kg. BT, CT, PT, Platelet count, Activated partial thromboplastin time were within normal limits. Chest radiograph and ECG were normal.

Brain MRI (1.5 tesla) revealed a hemorrhage in right basal ganglia extending into the right lateral ventricle [Figure 1][Figure 2].

A small thrombus in left sigmoid sinus and complete thrombosis of left jugular vein was noted [Figure 3][Figure 4].

MR angiography for the Cerebral vessels showed mild pinching of right Middle Cerebral Artery, secondary to mass effect due to hemorrhage and edema.

Doppler also showed complete thrombosis of Internal Jugular Vein on left side. Follow up CT scan was done after 2 days, which confirmed the findings.

 DISCUSSION



Altitude illness refers to a constellation of syndromes that result from hypoxic injury alone or in combination with various maladaptive physiological changes. Cerebral syndromes develop at a altitude of 2500 metres and everyone is at risk, regardless of the level of physical fitness or previous altitude experience.[1]

Rapid ascent to high altitude overtaxes the body's ability to tolerate decreasing availability of oxygen that causes changes in blood brain barrier permeability and results in vasogenic edema.

In rare cases focal neurological signs and deficits like IIIrd nerve palsy, VIth nerve palsy, stroke, and sinus venous thrombosis may develop. Pulmonary odema, DVT, pulmonary thromboembolism are also known to occur. HACE may present with altered mental status, progressive ataxia, coma & death.

HACE is characterized in MRI with reversible vasogenic white matter edema with a predilection for splenium of corpus callosum [2].

Hemorrhagic cerebral infarction can be induced by venous thrombosis a consequence of high altitude dehydration polycythaemia [3],[4].

SK Jha et al [5] reported that long term stay at high altitude was also associated with higher risk of stroke. Ischemic strokes were the commonest although all types of strokes were seen.

In our study the site of hemorrhage in right basal ganglia was indicative of an ischemic etiology. The filling defect in the sigmoid sinus and complete occlusion of the jugular vein was on the opposite side, could be a result of heamoconcentration leading to polycythemia.

References

1J Dickinson, D Heath, J Gosney, and D Williams. Altitude-related deaths in seven trekkers in the Himalayas. Thorax 1983;38:646-656.
2Peter H. Hackett, Philip R. Yarnell, Richard Hill, Kenneth Reynard, Joseph Heit, John McCormick. JAMA 1998 Dec 9; 280 (22): 1920-25.
3Shigeru Saito, So-kichi Tanaka. A Case of Cerebral Sinus Thrombosis Developed During a High-Altitude Expedition to Gasherbrum I. Wilderness and Environmental medicine vol 14, No 4, pp 226-230.
4Fijimaki J, Matsutani M, Asai A, Kohno T, Koike M. Cerebral venous thrombosis due to high-altitude polycythemia. J Neurosurgery 1986 Jan, 64 (1) : 148-50.
5Jha S K, Anand A C , Sharma V, Kumar N, Adya CM. Stroke at high altitude: Indian experience. High Alt Med Biol 2002 spring :3(1):21-7.