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The Putative Role of Vascular Endothelial Growth Factor in High Altitude Cerebral Oedema Essay

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The Putative Role of Vascular Endothelial Growth Factor in High Altitude Cerebral Oedema

High altitude cerebral oedema (HACE) is a severe and malignant form of acute mountain sickness (AMS) that can affect people who ascend rapidly to high altitude (typically above 2500m) without sufficient acclimatization.   The incidence of HACE is relatively low – Hackett and Rennie (1976) found 5 cases of HACE out of 278 unacclimatised climbers at an altitude of 4243m, giving an incidence of 1.8%.   The hallmarks of this high-altitude illness, differentiating it from severe AMS, are confusion and ataxia.   At the first sign of ataxia, if not before, descent is the most important form of treatment.   8mg dexamethasone should be administered immediately, followed by 4mg every 6 hours.   Supplemental oxygen should also be provided if available to facilitate descent.   HACE is a life-threatening illness and if left untreated, death will ensue.

The pathophysiology of HACE is unclear.   However, at present, it is widely accepted that HACE is hypoxia-induced and that this results in cerebral oedema of vasogenic origin, with an increase in the permeability of the blood-brain barrier (BBB).   Cerebral endothelial cells form the BBB, which regulates the homeostasis of the central nervous system in vivo.   The increased permeability of the cerebral endothelial cells may lead to movement of fluid and protein into extra cellular space in the brain, causing an increase in extra cellular fluid, accounting for the cerebral oedema seen in HACE.   Clinically, HACE can be characterized on MRI (magnetic-resonance imaging) scans by reversible white matter oedema of the brain, supporting this vasogenic mechanism [Hackett et al., 1998].   But what causes vasogenic oedema at high altitude?   Understanding the mechanism behind the vasogenic oedema apparent in severe AMS and HACE is vitally important, as there are implications for more effective clinical treatment of high-altitude illness, as well as...

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The Putative Role of Vascular Endothelial Growth Factor in High Altitude Cerebral Oedema. Anti Essays. Retrieved December 15, 2018, from the World Wide Web: http://teachingsail.com/free-essays/The-Putative-Role-Of-Vascular-Endothelial-586897.html


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