OBJECTIVEHigh-altitude cerebral edema (HACE) is one of the most serious acute mountain sickness and its underlying mechanism is still unknown clearly. The aim of this study was to determine the changes of plasma proteins in high altitude cerebral edema patients for discovering essential biomarkers used for the routine prophylaxis, diagnosis and treatment.

METHODSPlasma protein profiling two dimensional gel electrophoresis followed by mass spectrometry was used to explore protein alterations in one patient with high-altitude cerebral edema (HACE). Striking differences in two-dimensional gel proteomes of plasma were observed between high-altitude cerebral edema (HACE) and high-altitude pulmonary edema (HAPE) and between high-altitude cerebral edema (HACE) and mild acute mountain sickness (mAMS). Furthermore, apolipoprotein E altered in high-altitude cerebral edema was validated by ELISA.

RESULTSDifferent six spots were found in this study from the comparison between HACE and HAPE, and there were different six spots which were detected from the plasma of HACE patient in comparison to mAMS. Apolipoprotein E was identified in the two groups of comparative maps and results of ELISA consisted with the results of 2-DE.

CONCLUSIONIn this study, we used proteomic approach to explore HACE firstly and found different proteins that were probably associated with HACE. This would offer a clue to a better understanding of HACE for precaution, diagnosis and treatment.

Adult ; Altitude ; Altitude Sickness ; complications ; Apolipoproteins E ; blood ; Blood Proteins ; metabolism ; Brain Edema ; blood ; etiology ; Female ; Humans ; Proteomics ; methods

Acute mountain sickness (AMS) occurs commonly in hikers who are rapidly exposed to high altitude environments. Despite the numerous reports of AMS, few studies have reported pallidal lesions associated with altitude sickness. A previously healthy 49-yr-old Korean patient, after ascent to 4,700 m, suffered symptoms consistent with AMS. After returning home, the patient showed changes in personality characterized by abulia, indifference, and indecisiveness. T2 weighted brain magnetic resonance imaging showed high signal lesions involving bilateral globus pallidus. Our case suggests that globus pallidus injury should be included in the differential diagnosis of patients with personality or cognitive change after recovery from AMS.
Altitude ; Altitude Sickness/*complications ; Behavior ; Brain/pathology ; Brain Damage, Chronic/*etiology/pathology ; Environment ; Globus Pallidus/*pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mountaineering

Sudden ascent to high altitudes beyond 2,438 m can cause life-threatening complications such as acute mountain sickness and high altitude cerebral and pulmonary oedema. We present a case of pituitary apoplexy in a young man who ascended to high altitude gradually, after proper acclimatisation. He developed headache, nausea, vomiting and persistent hypotension. Magnetic resonance imaging revealed an enlarged pituitary gland with haemorrhage. His hormonal estimation showed acute adrenal insufficiency due to corticotropin deficiency. The patient responded well to conservative medical management with hormonal replacement therapy. This is most likely the first reported case of high altitude-induced pituitary apoplexy in the literature.
Acclimatization ; Adrenal Insufficiency ; complications ; Adrenocorticotropic Hormone ; deficiency ; Adult ; Altitude ; Altitude Sickness ; complications ; Brain ; pathology ; Hormone Replacement Therapy ; methods ; Humans ; Hypotension ; physiopathology ; Intracranial Hemorrhages ; physiopathology ; Magnetic Resonance Imaging ; methods ; Male ; Pituitary Apoplexy ; diagnosis ; etiology ; Pituitary Gland ; physiopathology

OBJECTIVETo explore the possible pathophysiological process and mechanisms underlying the development and formation of high altitude pulmonary edema(HAPE) by observing the changes in contents of VEGF, TNF-alpha, IL-6 and NO in serum from the initiated and recovery of HAPE patients.

METHODSWe studied 10 HAPE patients in a Chinese population. The patients were divided into two groups including HAPE initiate group and the recovery group. Contents of VEGF, TNF-alpha, IL-6 and NO in serum of the two groups were determined to study the process of HAPE.

RESULTSVEGF levels in the HAPE initiate one and the recovery groups were (167.9 +/- 26.5 and 53.1 +/- 17.0 pg/ ml), respectively. There was a significant decrease of VEGF content in recovery one compared to the HAPE group. The same results for TNF-alpha were gained. The levels of TNF-alpha in recovery group was much lower than that in the HAPE initiate one. They were (29.2 +/- 6.8) pg/ml and (86.2 +/- 24.1) pg/ml, respectively. The contents of IL-6 in HAPE initiate group and the recovery group were (32.3 +/- 16.5) pg/ml and (12. 5 +/- 8.0) pg/ml, respectively. But no significance existed. The level of NO in HAPE initiate group was (33.8 +/- 3.3) micromol/L, and it remarkably increased to (74.1 +/- 6.2) micromol/L in recovery one.

CONCLUSIONVEGF, TNF-alpha, IL-6 and NO participated in the different aspects of the pathophysiological process and might have influence on HAPE.

Adult ; Altitude ; Altitude Sickness ; complications ; physiopathology ; Humans ; Interleukin-6 ; blood ; Male ; Nitric Oxide ; blood ; Pulmonary Edema ; blood ; etiology ; physiopathology ; Tumor Necrosis Factor-alpha ; blood ; Vascular Endothelial Growth Factor A ; blood