Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness

Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness Abstract The pathophysiology of acute mountain sickness and high-altitude cerebral edema, the cerebral forms of high-altitude illness, remain uncertain and controversial. Persistently elevated or pathological fluctuations in intracranial pressure are thought to cause symptoms similar to those reported by individuals suffering cerebral forms of high-altitude illness. This review first focuses on the basic physiology of the craniospinal system, including a detailed discussion of the long-term and dynamic regulation of intracranial pressure. Thereafter, we critically examine the available literature, based primarily on invasive pressure monitoring, that suggests intracranial pressure is acutely elevated at altitude due to brain swelling and/or elevated sagittal sinus pressure, but normalizes over time. We hypothesize that fluctuations in intracranial pressure occur around a slightly elevated or normal mean intracranial pressure, in conjunction with oscillations in arterial P o 2 and arterial blood pressure. Then these modest fluctuations in intracranial pressure, in concert with direct vascular stretch due to dilatation and/or increased blood pressure transmission, activate the trigeminal vascular system and cause symptoms of acute mountain sickness. Elevated brain water (vasogenic edema) may be due to breakdown of the blood-brain barrier. However, new information suggests cerebral spinal fluid flux into the brain may be an important factor. Regardless of the source (or mechanisms responsible) for the excess brain water, brain swelling occurs, and a “tight fit” brain would be a major risk factor to produce symptoms; activities that produce large changes in brain volume and cause fluctuations in blood pressure are likely contributing factors. acute mountain sickness high-altitude cerebral edema headache and intracranial pressure Copyright © 2016 the American Physiological Society View Full Text Previous Next Back to top About the Cover About the Cover This is a PDF-only article. The first page of the PDF of this article appears below. Table of Contents Ed Board (PDF) Mml Math 1 Article Abstract PHYSIOLOGY OF THE CRANIOSPINAL SYSTEM HYPOXEMIA AND CSF DYNAMICS PERSPECTIVES FUTURE RESEARCH DIRECTIONS CONCLUSIONS GRANTS DISCLOSURES AUTHOR CONTRIBUTIONS REFERENCES Figures & Data Info E-letters PDF Alert me when this article is cited Alert me if a correction is posted Email Thank you for your interest in spreading the word on Journal of Applied Physiology. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness Message Subject (Your Name) has sent you a message from Journal of Applied Physiology Message Body (Your Name) thought you would like to see the Journal of Applied Physiology web site. Your Personal Message Print Citation Tools Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness Justin S. Lawley , Benjamin D. Levine , Michael A. Williams , Jon Malm , Anders Eklund , David M. Polaner , Andrew W. Subudhi , Peter H. Hackett , Robert C. Roach Journal of Applied Physiology Jan 2016, 120 (2) 251-262; DOI: 10.1152/japplphysiol.00370.2015 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Request Permissions Share Justin S. Lawley , Benjamin D. Levine , Michael A. Williams , Jon Malm , Anders Eklund , David M. Polaner , Andrew W. Subudhi , Peter H. Hackett , Robert C. Roach Journal of Applied Physiology Jan 2016, 120 (2) 251-262; DOI: 10.1152/japplphysiol.00370.2015 Permalink: Copy View Full Page PDF Tweet Widget Facebook Like Google Plus One Reddit CiteULike Mendeley StumbleUpon More in this TOC Section Parabolic flight as a spaceflight analog Effects of isolation and confinement on humans-implications for manned space explorations Pressure distension in leg vessels as influenced by prolonged bed rest and a pressure habituation regimen Show more Highlighted Topic Related Articles No related articles found. Web of Science PubMed Google Scholar Cited By... Translation in progress: Hypoxia 2015 Fulltext PDF Web of Science (1) Google Scholar Most Cited Most Read A new method for detecting anaerobic threshold by gas exchange Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. Calculation of substrate oxidation rates in vivo from gaseous exchange A method for measuring horizontal and vertical eye movement chronically in the monkey. Adaptations of skeletal muscle to endurance exercise and their metabolic consequences More... Featured Articles Featured Podcasts Greater loss in muscle mass and function but smaller metabolic alterations in older compared with younger men following 2 wk of bed rest and recovery Relationship of brown adipose tissue perfusion and function: a study through β2-adrenoreceptor stimulation Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation Voluntary Physical Activity Abolishes the Proliferative Tumor Growth Microenvironment Created by Adipose Tissue in Animals Fed a High Fat Diet Predicting Ventilator-Induced Lung Injury Using a Lung Injury Cost Function Measurement of Intra-individual Airway Tone Heterogeneity and its Importance in Asthma GA_googleFillSlot("jap_tower_right_160x600"); Navigate Current Issue Articles in Press Archives Feedback Submit Subscribe Personal Alerts More Information About this Journal Information for Authors Submit a Manuscript Press Advertising AuthorChoice Calls for Papers Ethics Policies PubMed Central Policy Reprints and Permissions Institutional Administrators APS Publications News Follow APS Publications on Twitter American Physiological Society Journals Cell Physiology Advances in Physiology Education Comprehensive Physiology Endocrinology and Metabolism Gastrointestinal and Liver Physiology Heart and Circulatory Physiology Journal of Applied Physiology Journal of Neurophysiology Lung Cellular and Molecular Physiology Physiological Genomics Physiological Review Physiology Regulatory, Integrative and Comparative Physiology Renal Physiology Physiological Reports Legacy Content APS Select www.physiology.org Copyright © 2016 The American Physiological Society | Print ISSN: 8750-7587 | Online ISSN: 1522-1601 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Applied Physiology The American Physiological Society

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The American Physiological Society
Copyright
Copyright © 2016 the American Physiological Society
ISSN
8750-7587
eISSN
1522-1601
D.O.I.
10.1152/japplphysiol.00370.2015
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Abstract

Abstract The pathophysiology of acute mountain sickness and high-altitude cerebral edema, the cerebral forms of high-altitude illness, remain uncertain and controversial. Persistently elevated or pathological fluctuations in intracranial pressure are thought to cause symptoms similar to those reported by individuals suffering cerebral forms of high-altitude illness. This review first focuses on the basic physiology of the craniospinal system, including a detailed discussion of the long-term and dynamic regulation of intracranial pressure. Thereafter, we critically examine the available literature, based primarily on invasive pressure monitoring, that suggests intracranial pressure is acutely elevated at altitude due to brain swelling and/or elevated sagittal sinus pressure, but normalizes over time. We hypothesize that fluctuations in intracranial pressure occur around a slightly elevated or normal mean intracranial pressure, in conjunction with oscillations in arterial P o 2 and arterial blood pressure. Then these modest fluctuations in intracranial pressure, in concert with direct vascular stretch due to dilatation and/or increased blood pressure transmission, activate the trigeminal vascular system and cause symptoms of acute mountain sickness. Elevated brain water (vasogenic edema) may be due to breakdown of the blood-brain barrier. However, new information suggests cerebral spinal fluid flux into the brain may be an important factor. Regardless of the source (or mechanisms responsible) for the excess brain water, brain swelling occurs, and a “tight fit” brain would be a major risk factor to produce symptoms; activities that produce large changes in brain volume and cause fluctuations in blood pressure are likely contributing factors. acute mountain sickness high-altitude cerebral edema headache and intracranial pressure Copyright © 2016 the American Physiological Society View Full Text Previous Next Back to top About the Cover About the Cover This is a PDF-only article. The first page of the PDF of this article appears below. Table of Contents Ed Board (PDF) Mml Math 1 Article Abstract PHYSIOLOGY OF THE CRANIOSPINAL SYSTEM HYPOXEMIA AND CSF DYNAMICS PERSPECTIVES FUTURE RESEARCH DIRECTIONS CONCLUSIONS GRANTS DISCLOSURES AUTHOR CONTRIBUTIONS REFERENCES Figures & Data Info E-letters PDF Alert me when this article is cited Alert me if a correction is posted Email Thank you for your interest in spreading the word on Journal of Applied Physiology. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness Message Subject (Your Name) has sent you a message from Journal of Applied Physiology Message Body (Your Name) thought you would like to see the Journal of Applied Physiology web site. Your Personal Message Print Citation Tools Cerebral spinal fluid dynamics: effect of hypoxia and implications for high-altitude illness Justin S. Lawley , Benjamin D. Levine , Michael A. Williams , Jon Malm , Anders Eklund , David M. Polaner , Andrew W. Subudhi , Peter H. Hackett , Robert C. Roach Journal of Applied Physiology Jan 2016, 120 (2) 251-262; DOI: 10.1152/japplphysiol.00370.2015 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Request Permissions Share Justin S. Lawley , Benjamin D. Levine , Michael A. Williams , Jon Malm , Anders Eklund , David M. Polaner , Andrew W. Subudhi , Peter H. Hackett , Robert C. Roach Journal of Applied Physiology Jan 2016, 120 (2) 251-262; DOI: 10.1152/japplphysiol.00370.2015 Permalink: Copy View Full Page PDF Tweet Widget Facebook Like Google Plus One Reddit CiteULike Mendeley StumbleUpon More in this TOC Section Parabolic flight as a spaceflight analog Effects of isolation and confinement on humans-implications for manned space explorations Pressure distension in leg vessels as influenced by prolonged bed rest and a pressure habituation regimen Show more Highlighted Topic Related Articles No related articles found. Web of Science PubMed Google Scholar Cited By... Translation in progress: Hypoxia 2015 Fulltext PDF Web of Science (1) Google Scholar Most Cited Most Read A new method for detecting anaerobic threshold by gas exchange Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. Calculation of substrate oxidation rates in vivo from gaseous exchange A method for measuring horizontal and vertical eye movement chronically in the monkey. Adaptations of skeletal muscle to endurance exercise and their metabolic consequences More... Featured Articles Featured Podcasts Greater loss in muscle mass and function but smaller metabolic alterations in older compared with younger men following 2 wk of bed rest and recovery Relationship of brown adipose tissue perfusion and function: a study through β2-adrenoreceptor stimulation Chronic endurance exercise training offsets the age-related attenuation in contraction-induced rapid vasodilation Voluntary Physical Activity Abolishes the Proliferative Tumor Growth Microenvironment Created by Adipose Tissue in Animals Fed a High Fat Diet Predicting Ventilator-Induced Lung Injury Using a Lung Injury Cost Function Measurement of Intra-individual Airway Tone Heterogeneity and its Importance in Asthma GA_googleFillSlot("jap_tower_right_160x600"); Navigate Current Issue Articles in Press Archives Feedback Submit Subscribe Personal Alerts More Information About this Journal Information for Authors Submit a Manuscript Press Advertising AuthorChoice Calls for Papers Ethics Policies PubMed Central Policy Reprints and Permissions Institutional Administrators APS Publications News Follow APS Publications on Twitter American Physiological Society Journals Cell Physiology Advances in Physiology Education Comprehensive Physiology Endocrinology and Metabolism Gastrointestinal and Liver Physiology Heart and Circulatory Physiology Journal of Applied Physiology Journal of Neurophysiology Lung Cellular and Molecular Physiology Physiological Genomics Physiological Review Physiology Regulatory, Integrative and Comparative Physiology Renal Physiology Physiological Reports Legacy Content APS Select www.physiology.org Copyright © 2016 The American Physiological Society | Print ISSN: 8750-7587 | Online ISSN: 1522-1601

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Journal of Applied PhysiologyThe American Physiological Society

Published: Jan 15, 2016

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