HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Appenzeller, O. Articles by Milner, P. Search for Related Content PubMed PubMed Citation Articles by Appenzeller, O. Articles by Milner, P. Related Collections All Neuromuscular Disease Peripheral neuropathy

Acral paresthesias in the Andes and neurology at sea level

From the New Mexico Health Enhancement and Marathon Clinics Research Foundation (Dr. Appenzeller), Albuquerque; Institute of Neurology (Dr. Thomas) and St. Bartholomew’s and the Royal London Hospitals (Dr. Ponsford), London, UK; Laboratorio de Transporte de Oxigeno Universidad Peruana Cayetano Heredia (Drs. Gamboa and Cáceda), Lima, Peru; and Autonomic Neuroscience Institute (Dr. Milner), Royal Free and University College Medical School, London, UK.

Address correspondence and reprint requests to Dr. Otto Appenzeller, NMHEMC Research Foundation, 361, Big Horn Ridge, NE, Albuquerque, NM 87122; e-mail: ottoarun12{at}aol.com or oarun@unm.edu

Background: Thirty-nine percent of permanent altitude dwellers in the Andes experience acral paresthesias.

Methods: Clinical examinations, sural nerve biopsies, and electrodiagnostic studies on peripheral nerves were performed on 15 men. Ten Cerro de Pasco (CP) natives living at 4,338 meters were biopsied. Three of these subjects had no burning feet/burning hands (BF/BH); three had BF/BH; and four had chronic mountain sickness (CMS), a maladaptation syndrome resulting from living in the Andes, all with BF/BH. Three patients with CMS were biopsied in Lima within hours after leaving CP. Two normal Lima natives were biopsied in Lima. Symptom scores for BF/BH and CMS score ratings were used. The nerves were assayed for Na⁺, K⁺ adenosine triphosphatase (ATPase), cytochrome oxidase (CO), substance P (SP), and endothelin (ET).

Results: Low ATPase was inversely related to symptom scores and CMS scores (p < 0.001). Patients with CMS biopsied in normoxia (Lima) had ATPase levels similar to those of controls. Nerve motor conduction velocities and sensory action potentials were normal. CO was inversely related to age (p < 0.03) and no relation of SP to any variable was found. ET levels were lower in sea level natives (p = 0.04).

Conclusions: Acral paresthesias are associated with low ATPase in peripheral nerves. Lower ET levels of sea level natives likely reflect lowered release from vasa nervorum.

This article has been cited by other articles:

				O. Appenzeller, V. E. Claydon, G. Gulli, C. Qualls, M. Slessarev, G. Zenebe, A. Gebremedhin, and R. Hainsworth Cerebral Vasodilatation to Exogenous NO Is a Measure of Fitness for Life at Altitude * Online Material Stroke, July 1, 2006; 37(7): 1754 - 1758. [Abstract] [Full Text] [PDF]