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Optic nerve sheath diameter correlates with the presence and severity of acute mountain sickness: evidence for increased intracranial pressure

¹Himalayan Rescue Association, Pheriche Clinic, Spring Season 2006, Nepal; ²Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; ³Division of Medical Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington; ⁴Emergency Department, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; and ⁵Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Submitted 8 November 2007 ; accepted in final form 30 December 2008

Increased intracranial pressure is suspected in the pathogenesis of acute mountain sickness (AMS), but no studies have correlated it with the presence or severity of AMS. We sought to determine whether increased optic nerve sheath diameter, a surrogate measure of intracranial pressure, is associated with the presence and severity of AMS. We performed a cross-sectional study of travelers ascending through Pheriche, Nepal (4,240 m), from March 3 to May 14, 2006. AMS was assessed using the Lake Louise score. Optic nerve sheath diameter was measured by ultrasound. Ultrasound exams were performed and read by separate blinded observers. Two-hundred eighty seven subjects were enrolled. Ten of these underwent repeat examination. Mean optic nerve sheath diameter was 5.34 mm [95% confidence interval (CI) 5.18–5.51 mm] in the 69 subjects with AMS vs. 4.46 mm (95% CI 4.39–4.54 mm) in the 218 other subjects (P < 0.0001). There was also a positive association between optic nerve sheath diameter and total Lake Louise score (P for trend < 0.0001). In a multivariate logistic regression model of factors associated with AMS, optic nerve sheath diameter was strongly associated with AMS (odds ratio 6.3; 95% CI, 3.7–10.8; P < 0.001). In 10 subjects with repeat examinations, change in Lake Louise score had a strong positive correlation with change in optic nerve sheath diameter (R² = 0.84, P < 0.001). Optic nerve sheath diameter, a proxy for intracranial pressure, is associated with the presence and severity of AMS.

hypoxia; high altitude