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October 9, 2013

Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema

November 12, 2013 issue
81 (20) 1776-1779

Abstract

Objective:

Based on recent findings of microhemorrhages (MHs) in the corpus callosum (CC) in 3 individuals after nonfatal high-altitude cerebral edema (HACE), we hypothesized that hemosiderin depositions in the brain after high-altitude exposure are specific for HACE and remain detectable over many years.

Methods:

This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had experienced HACE, 8 high-altitude pulmonary edema, 11 severe acute mountain sickness, and 8 had climbed to altitudes ≥6,962 m without developing any high-altitude illness. HACE was defined as ataxia necessitating assistance with walking and/or decreased consciousness. Within <1 to 38 months after the qualifying incident, MRI of the brain was performed using a 3-tesla scanner and high-resolution susceptibility-weighted magnetic resonance sequences for detection of hemosiderin depositions, which were quantified by a score.

Results:

Unequivocal MHs located in the splenium of the CC were found in 8 subjects and questionable MHs were found in 2 subjects 1 to 35 months after HACE. They were located outside the CC in 5 more severe cases. MHs remained unchanged in those reexamined after 12 to 50 months. A few unequivocal MHs in the splenium of the CC were found in one subject after severe acute mountain sickness, while one subject with high-altitude pulmonary edema and 2 of the extreme altitude climbers had questionable lesions. In all other subjects, MHs were unequivocally absent.

Conclusions:

MHs detectable by susceptibility-weighted MRI predominantly in the splenium of the CC are long-lasting footprints of HACE.

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Supplementary Material

File (appendix_e-1.doc)
File (figure_e-1.doc)
File (table_e-1.doc)
File (table_e-2.docx)

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Information & Authors

Information

Published In

Neurology®
Volume 81Number 20November 12, 2013
Pages: 1776-1779
PubMed: 24107867

Publication History

Received: May 13, 2013
Accepted: August 19, 2013
Published online: October 9, 2013
Published in print: November 12, 2013

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Kai Schommer, MD*
From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B.), and Department of Neurology, Division of Neuroradiology (K.L.), University Hospital, Heidelberg; and Neuroradiology (K.K., M.K.), University Medicine, Göttingen, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kai Kallenberg, MD*
From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B.), and Department of Neurology, Division of Neuroradiology (K.L.), University Hospital, Heidelberg; and Neuroradiology (K.K., M.K.), University Medicine, Göttingen, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
(1) commercial [not associated to this sutdy]: ACANDIS GmbH & Co. KG Theodor-Fahrner-Str. 6 75177 Pforzheim Germany 1. IROS 2011, Salzburg, 13. - 15.01.20112. CIRSE 2012, Lisbon, Portugal September 15-19 2012. 3. IROS Interventionell Radiologiesches Olbert Symposium Berlin, Germany 17-19.01.20134. RSNA 2012, Chicago IL/USA, November 25 - 30.
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Kira Lutz, MD
From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B.), and Department of Neurology, Division of Neuroradiology (K.L.), University Hospital, Heidelberg; and Neuroradiology (K.K., M.K.), University Medicine, Göttingen, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Peter Bärtsch, MD
From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B.), and Department of Neurology, Division of Neuroradiology (K.L.), University Hospital, Heidelberg; and Neuroradiology (K.K., M.K.), University Medicine, Göttingen, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1. Bayer Health Care, Honorarium for lecture2. MSD Sharp & Dohme: honorarium for lectures
Editorial Boards:
1.
High Altitude Medicine and Biology, International Journal of Sports Medicine
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
1. Bayer HC: honorarium for lecture2. MSD Sharp & Dohme: honorarium for lectures3. Geratherm: Support of Symposium4. Linde AG Berlin: Support of Symposium
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Michael Knauth, MD
From the Department of Internal Medicine, Division VII: Sports Medicine (K.S., P.B.), and Department of Neurology, Division of Neuroradiology (K.L.), University Hospital, Heidelberg; and Neuroradiology (K.K., M.K.), University Medicine, Göttingen, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
(1) Head coil for intraoperative MR imaging
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
(1) Siemens AG: speaker honorarium(2) Bayer AG: speaker honorarium(3) Codman AG: speaker honorarium
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Bärtsch: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
These authors contributed equally to this work.

Author Contributions

Kai Schommer: designing the study, recruiting patients, analysis of data, involved in writing. Kai Kallenberg: designing the study, performing and analyzing the MRIs, data analysis, involved in writing. Kira Lutz: involved in performing MRI, analyzing data, and writing. Peter Bärtsch: designing the study, recruiting patients, analysis of data, drafting the manuscript. Michael Knauth: designing the study, performing and analyzing the MRIs, data analysis, involved in writing.

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