NEURAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 189

whichusuallywouldrequireurgentevacuation.Highbloodconcentrationsoftheantibiotic
are required for therapeutic quantities to get into the brain and cerebrospinal fluid where
the infection is located. Ceftriaxone (Rocephin®) is the drug of choice for individuals who
are not allergic to penicillin. Penicillin or ampicillin can be administered if ceftriaxone is
not available. If the individual has anaphylactic reactions to penicillin, that would be an-
other indication of the need for urgent evacuation.
Feveraccompanyingtheseinfectionscanbehighandshouldbeloweredifitgoesabove
104°F (40°C) orally. Acetaminophen, ibuprofen, or aspirin can be given every four hours.
Cooling by covering the arms and legs with wet cloths or clothing and fanning may be re-
quired.
The headache that accompanies these disorders is frequently severe but can usually
be controlled with acetaminophen, ibuprofen, or aspirin—possibly combined with
codeine—every four hours. Medications for sleep or medications for pain stronger than
codeine should not be given because they depress brain function.
Fluid balance must be maintained; intravenous fluids may be necessary. Coma requires
the same care as unconsciousness from any cause. Movement to low altitudes or oxygen
administration is desirable. The person should be isolated with a limited number of attend-
ants to prevent spread of the disease. Evacuation to a hospital is essential. Approximately
25 percent of adult meningitis is fatal, and survivors typically require prolonged rehabilita-
tion. Death rates for encephalitis can be even higher.
Stroke
Stroke is a term for a group of disorders that are also called cerebral vascular accidents
because obstruction orruptureofarteries inthebraindestroysthetissue theysupply.Inthe
UnitedStatesstrokeisthethirdmostcommoncauseofdeath.Approximately80percentof
strokes are caused by clotting of blood within an artery, which causes the death (necrosis
or infarction) of tissue supplied by that blood vessel. The other 20 percent are the result of
hemorrhage, which can obliterate significant portions of the brain.
Most strokes result from arteriosclerosis (hardening of the arteries), are associated with
highbloodpressure,andoccurinolderpeople.However,strokescanoccurinyoungadults
with severe, untreated hypertension. The dehydration and increased number of red blood
cells typical of high altitudes increase the risk of stroke. One type of stroke (subarachnoid
hemorrhage) originates from aneurysms of the cerebral arteries.
The individuals most likely to have strokes on wilderness expeditions are members of
support teams, such as porters. Many of these individuals have never had any professional
medical care, not even a routine physical examination, and high blood pressure could not
have been detected. They should be screened for hypertension, as well as other diseases,
particularly infectious diseases such as tuberculosis, and affected individuals should be ex-
cluded from the expedition, although the political situation in many areas does not permit