Neurological manifestations in chronic mountain sickness: the burning feet-burning hands syndrome

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 69; no. 4; pp. 447 - 452
• Main Authors: Thomas, P K, King, R H M, Feng, S F, Muddle, J R, Workman, J M, Gamboa, J, Tapia, R, Vargas, M, Appenzeller, O
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2000; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Aged; Altitude; Altitude Sickness - pathology; Altitude Sickness - physiopathology; Ataxia; Biological and medical sciences; Biopsy; burning feet-burning hands syndrome; Chronic Disease; chronic mountain sickness; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Female; Headaches; Humans; hypoxia; Male; Medical sciences; Microscopy, Electron; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Peripheral Nervous System Diseases - pathology; Peripheral Nervous System Diseases - physiopathology; Peripheral neuropathy; Sea level; Sural Nerve - pathology; Sural Nerve - physiopathology; South America; Peru; America; Human; Acute mountain sickness; Symptomatology; Nervous system diseases; Chronic; Biopsy; Exploration; Peripheral nerve disease; Peripheral neuropathy; Sural nerve
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.69.4.447

OBJECTIVE To characterise the clinical features and nerve biopsy findings in patients with chronic mountain sickness (CMS) living in the Peruvian Andes, with particular attention to the occurrence of the “burning feet-burning hands” syndrome. METHODS Symptoms and signs were documented clinically in 10 patients with CMS and compared with those in five healthy subjects all living at 4338 metres altitude. Sural nerve biopsies were obtained from three patients with CMS.The nerve fibre population and endoneurial microvessels were analyzed morphometrically. RESULTS All patients with CMS experienced burning and tingling paraesthesiae in the distal parts of their limbs. Similar but milder symptoms confined to the feet occurred in four of five controls. Three patients with CMS had a mild sensory neuropathy on examination, controls were clinically normal. Nerve biopsies showed a mild demyelinating neuropathy in all three with a reduction in the unmyelinated axon population in one. The endoneurial blood vessels showed a reduced thickness in the basal laminal zone compared with control values but were otherwise normal. CONCLUSIONS Apart from well recognised symptoms and signs of CMS, the study has shown that such patients may also exhibit a mild sensory neuropathy. Its relation to the burning feet-burning hands syndrome, which was not confined to the patients but was also found in controls at altitude, is uncertain. The time course and pattern of the centrifugal resolution of the burning paraesthesiae complex on low altitude sojourn of high altitude natives raises the possibility that a mechanism involving altered axonal transport may be involved. The reduced thickness of the basal laminal zone of microvessels implies that adaptive structural changes to hypobaric hypoxia may also occur in peripheral nerve and are similar to those reported in other tissues of high altitude natives.