Packs and Strokes

The health problems which confront backpackers are rarely consequential, and certainly less important than the overall very positive impact on health which spending time in the wilderness conveys. Every now and then, however, something potentially serious comes up. Ignoring signs of trouble in the front country can be dangerous, but the rapid availablity of emergency medical services may compensate for earlier delays. The back country, however, is far less forgiving.

I was reminded of this the other day, upon reading and responding to a question posed by a visitor to my website. This gentleman was on a hike in the northeast when he began to experience some tingling and weakness of one arm, accompanied by facial weakness and slurring of speech; fortunately, this resolved on its own over a few minutes. Nonetheless, he rightly worred about this, headed out, and spent some time in a hospital. In retrospect, he wondered if all of this could have been caused by too-tight backpack straps.

The quick answer to his question was "of course not". These sudden changes in his neurologic status could have represented a stroke; the fact that they resolved within minutes defined them as a "mini stroke" or transient ischemic attack (TIA). If it had been the start of an actual stroke, he would have had a very narrow time window of opportunity to receive a therapy which could prevent or minimize the develoment of long-term disability. In fact, this time window is so short I believe that a "walk out" evacuation (assuming the group is within an hour or so of a trail head and the individual is stable enough to walk) is preferable to staying put and sending for help.

The notion that this could have been caused by pack straps, however, is not unreasonable. I have written extensively about this in an article on this website. Go to the "publications" link and find the article curiously entitled "On numbness and tingling". Pressure of straps from a backpack on the nerves supplying the arms frequently causes numbness and tingling. This almost always occurs in both arms, however, and should never be accompanied by speech problems, facial weakness, or other features.

For more information on the recognition and emergency treatment of stroke, visit the American Heart Association website: http://www.strokeassociation.org/presenter.jhtml?identifier=1020.