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<a href="http://doi.org/10.1227/01.NEU.0000327885.15132.CA" target="_blank" rel="noreferrer">http://doi.org/10.1227/01.NEU.0000327885.15132.CA</a>
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Title
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Direct measurement of intracranial pressure at high altitude and correlation of ventricular size with acute mountain sickness: Brian Cummins' results from the 1985 Kishtwar expedition
Publisher
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Neurosurgery
Date
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2008
Subject
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Humans; Male; Young Adult; Adult; Middle Aged; Severity of Illness Index; Intracranial Pressure; Acute Disease; adolescent; Tomography; X-Ray Computed; India; Altitude Sickness/diagnosis/etiology/physiopathology; Brain/complications/physiopathology; Cerebral Ventricles/physiopathology; Expeditions; Experimental; Headache/etiology; Hypoxia; Implants; Intracranial Hypertension/diagnosis/etiology; Physical Exertion; Telemetry/instrumentation
Creator
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Wilson MH; Milledge J
Description
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OBJECTIVE AND IMPORTANCE: The "tight-fit" hypothesis and subsequent current understanding of acute mountain sickness (AMS) is that individuals with less compliant cerebrospinal fluid systems (smaller ventricles and cerebrospinal fluid spaces) have a greater increase in intracranial pressure (ICP) for a given increase in brain volume as a result of hypoxic cerebral edema. There has only been 1 study of direct (telemetric) ICP measurement at high altitude. This was performed in 1985 on 3 subjects by Brian Cummins up to a maximum height of 16,500 ft (5030 m). The group also investigated the "tight-fit" hypothesis by correlating computed tomographic scans that measured ventricular size (read blindly) with headache score and AMS symptomatology in 10 subjects. Unfortunately, the data were thought to have been destroyed by fire, and, hence, the findings were not published. The data have now been rediscovered, and this article reviews the methodology and findings of this unique piece of work. RESULTS: The ICP monitoring study demonstrated that ICP remained normal at rest at all altitudes; however, in the single subject with AMS, there was a dramatic increase in ICP even on minimal exertion. The computed tomographic scan analysis of brain compliance demonstrated an inverse correlation between ventricular size and headache score. CONCLUSION: This unique research, which is unlikely to ever be repeated, is the only report of direct ICP measurement at high altitude. This and the computed tomographic study provide the first objective evidence supporting the "tight-fit" hypothesis of AMS.
2008
Identifier
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<a href="http://doi.org/10.1227/01.NEU.0000327885.15132.CA" target="_blank" rel="noreferrer">10.1227/01.NEU.0000327885.15132.CA</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
2008
Acute Disease
Adolescent
Adult
Altitude Sickness/diagnosis/etiology/physiopathology
Backlog
Brain/complications/physiopathology
Cerebral Ventricles/physiopathology
Expeditions
Experimental
Headache/etiology
Humans
Hypoxia
Implants
India
Intracranial Hypertension/diagnosis/etiology
Intracranial Pressure
Journal Article
Male
Middle Aged
Milledge J
Neurosurgery
Physical Exertion
Severity Of Illness Index
Telemetry/instrumentation
Tomography
Wilson MH
X-Ray Computed
Young Adult