2
HAI- New Developments
· Epidemiology
· Susceptibility
· Pathophysiology
· Treatment
Evolving Definition and Scoring
· Old:
LLS (not sufficiently specific), AMS-c (not
sufficiently sensitive), varies with altitude and
population
· Gold standard: "
I feel sick
," reduced activity
· New: HAH as main focus of research for AMS
Silber et al, Clinical Features of HAH, Neurology 2003
· HACE
Incidence of AMS: New Studies
· Ashyrbaev et al., Kumtor mine site, Kyrgyz Rep
· Subedi et al, Nepal
· O'Connor et al, Mt Rainier
· Pesce et al, Aconcagua
· Jean, Peru, Bolivia and Chile (Children)
· Silva, Chile (Children)
· Schneider et al, Alps (Headache, n=1213!)
· www.ismmed.org
Susceptibility
· Schneider et al, MSSE 2003, Bartsch 2004
827 mountaineers, usual variables
Risk factors:
· Susceptibility in past (HAH)
· Rate of ascent
· HA exposure in prev 2 months
Slow ascent, freq exposure reduces AMS 5X
Susceptibility - HAPE
· Explosion in genetic studies
Pathophysiology of AMS
· Is AMS due to mild cerebral edema?
· MRI studies with DWI, T2WI, SIENA
Fischer et al (Cephalgia, 2004)
Morocz et al Neurology, 2001)
Schoonman, Kallenberg (in press)
Bailey (J Physiol, 2003)
Roach et al (in press)
