What is high altitude cerebral edema, the killer complication that caused the death of the mountaineer Luca Sinigaglia

THE’High altitude cerebral edema (in English High Altitude Cerebral EdemaHace) is a serious complication of the exposure to high altitudes, linked to acute mountain pain that worsens And it is among the killer More feared by those who climb over 3000 meters.

A few days ago he caused the death of the Italian mountaineer Luca Sinigagliaclimbing at high altitude on Pik Pobeda, the highest peak of the Tian Shan chain, between Kyrgyzstan and China, to save a Russian colleague.

It consists of an accumulation of liquids in the brain that causes an increase in intracranial pressure. It typically appears above 3,500–4.000 metersbut it can also occur lower in sensitive people or with too quick ascent. «Altitude edema is what is commonly called mountain pain “explains Francesco Zenga, Basicranium neurosurgery director and pituitaryMolinette Hospital City of Health and Sciences of Turin. “But ocorre make a distinction: on the one hand there is the mountain pain that can affect any tourist at 2,500–3,000 meters, on the other what interests the professional mountaineer and which represents the serious form. In this second case it is no longer a mild disorder, but a real cerebral edema ». It is a well -known condition in neurology and neurosurgery: “Since the brain is enclosed inside the skull, a rigid and closed structure, the presence of edema inevitably causes an increase in intracranial pressure”.

Hace: Because it arises

The main cause is thehypoxiathat is, the reduced availability of oxygen in the blood. It is not the amount of air oxygen that changes, but the partial pressure of oxygen, which decreases with altitude. The lungs, therefore, manage to absorb much less, causing a respiratory deficit critic. Zenga specifies: «When the pressure inside the skull increase significantly, the regular blood flow which should reach the brain through the carotid and vertebral arteries can no longer enter, blocked by excessive intracranial pressure». What triggers the hypoxia is the quick ascent without adequate acclimatation.

Symptoms and therapies

The increase in pressure inside the skull causes a series of symptoms that can start with heachache, nausea And vomit, confusion, behavior changes, Difficulty walking in a straight line (ataxia), drowsiness To then evolve into loss of consciousness, coma and, in the most serious cases, death In a few hours.

What to do in case of high altitude cerebral edema? If the symptoms appear, it is essential to intervene immediately, the specialist points out: «The first thing to do is administer oxygenThen drop quicklyeven little: sometimes they are also enough 300 or 500 meters To save a person’s life ».
Also take specific drugs, such as theacetazolamide In some cases it may be useful to reduce the risk of developing the disease. “It is a medicine used in different pathologies, also of a neurological type, such as the intraochoric hypertension, thanks to its ability to reduce intracranial pressure,” Zenga points out. “Precisely for this reason, it is sometimes also taken by those who have to face ascents at high altitude”.

For rescue, the timing is truly fundamental: «If the edema is tthrilling promptlyyou can have what in medicine is called restitutio ad integrum: The symptoms disappear and the patient does not present consequences. However, when cerebral edema is widespread and the flow of oxygen to the brain is significantly reduced, they can arise ischemias: that, once established, they are not reversible and therefore cause permanent damage to the brain “

Prevention: the importance of acrim for

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The most effective way for prevent The high altitude pulmonary edema is thegradual acclimatization.

Acclimatization is the process that our body puts in place when we go up to the share and start breathing a so on so to speak rarefied, We read on the site Italian Alpine Guides. Climbing the quota decreases the barometric pressuretherefore, while remaining constant the percentage of oxygen (respiratory gas) decreases the pressure with which it is dissolved in the air, and consequently the quantity of oxygen that we are able to introduce into the lungs and transport in the blood (hypobaric hypobaric) decreases. Through changes to be paid by various organs and apparatuses, especially of the cardio-respiratory system, the body adapts to the decreased barometric pressure and hyposia, in order to be able to carry out physical activity such as walking and climbing with a reduced performance, but still sufficient to achieve their goals. The acclimatization therefore requires time. Professional mountaineers adopt precise strategies:

• Go up a little at a time (no more than 600–800 m in altitude per day above 2,500 m)
• Predict days of rest in the basic fields
• Alternate climbs and descents to allow the body to adapt: ​​”If, for example, there is base At 5,000 meters the day after the climbers go up to 6,500, then they go down to 5,500. They must acclimatize, waiting a few days before being able to go up again », explains the neurosurgeon and adds:” Often the problem of mountain pain is also associated with another edema: thehigh altitude pulmonary edema (hape), And often the two pathologies are confused ». Even the high altitude pulmonary edema is a serious complication of the mountain pain that can arise during the ascents above 2,500–3,000 meters. It is an accumulation of liquids in the pulmonary alveoli that reduces respiratory capacity and puts life at risk: high altitude cerebral edema and pulmonary edema from high altitude can manifest themselves together. Are the main ones altitude diseases, With sometimes fatal consequences.