Cases reported "Altitude Sickness"

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1/37. Experimental use of a transportable hyperbaric chamber durable for 15 psi at 3700 meters above sea level.

    A transportable hyperbaric chamber durable for 15 psi of pressure was used to treat a patient suffering from moderate acute mountain sickness at 3700 m above sea level. The symptoms were ameliorated a few minutes after pressurization in the chamber. After a 20-minute stay in the chamber, the patient was completely free of symptoms. Since the chamber can be inflated by using compressed air from a cylinder, no strenuous work was required of the operators. This transportable chamber seems to be useful for the treatment of high-altitude disorders at around 3000 m above sea level.
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2/37. High-altitude global amnesia.

    A variety of transient focal neurological signs presenting at high altitude have been described without associated acute mountain sickness or other concurrent illness. We report a case series of transient global amnesia at high altitude. The term high-altitude global amnesia (HAGA) is introduced to indicate this condition, and the pathophysiology is discussed. We hypothesize that because of the highly variable ventilatory response to hypoxia and to individual cerebral vasomotor reactivity, individuals with a marked hyperventilatory response could experience significant hypocapnic cerebral vasoconstriction that in turn could cause local hypoxia or ischemia to particular regions of the brain and resulting transient focal neurological impairment.
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3/37. High-altitude cerebral edema (HACE): the Denver/Front Range experience.

    High-altitude cerebral edema (HACE) is a potentially fatal metabolic encephalopathy associated with a time-dependent exposure to the hypobaric hypoxia of altitude. Symptoms commonly are headache, ataxia, and confusion progressing to stupor and coma. HACE is often preceded by symptoms of acute mountain sickness and coupled, in its severe form, with high-altitude pulmonary edema. Although HACE is mostly seen at altitudes above that of the Denver/Front Range visitor-skier locations, we report our observations over a 13-year period of skier-visitor HACE patients. It is believed that this is a form of vasogenic edema, and it is responsive to expeditious treatment with a successful outcome.
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4/37. myocardial infarction or high-altitude pulmonary edema?

    We report the case of a 60-year-old European man with myocardial infarction at high altitude (4000 m). myocardial infarction is an uncommonly encountered problem in high-altitude trekking in the Himalayas. The paucity of coronary artery disease at high altitude (hypoxia, exercise, and age not-withstanding) is discussed. Finally, the importance of recognizing disease entities that mimic acute mountain sickness in this environment is emphasized.
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5/37. Assessment of high altitude tolerance in healthy individuals.

    The most reliable prediction of high altitude tolerance can be derived from the clinical history of previous comparable exposures. Unfortunately, there are no reliable tests for prediction prior to first-time ascents. Although susceptibility to AMS is usually associated with a low hypoxic ventilatory response (HVR), there is too much overlap with the range of normal values, which precludes measuring HVR or O(2) saturation during brief hypoxia for reliable identification of susceptibility to AMS. A low HVR and an exaggerated rise in pulmonary artery pressure with (prolonged) hypoxia, or exercise in normoxia, are markers of susceptibility to high altitude pulmonary edema (HAPE). These tests can not be recommended for routinely determining high altitude tolerance because the prevalence of susceptibility to HAPE is low and because specificity and sensitivity of these tests are not sufficiently established. On the other hand, HAPE may be avoided in susceptible individuals by ascent rates of 300 m per day above an altitude of 2000 m. Since prediction of risk of mountain sickness is difficult, it is important during the physician consultation prior to ascent to consider the altitude profile, the type of ascent, the performance capacity, the history of previous exposures, and the medical infrastructure of the area.
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6/37. High altitude retinal hemorrhages in a colorado skier.

    High altitude retinal hemorrhages are commonly seen at altitudes above 4270 m. While these hemorrhages are generally asymptomatic, macular involvement may result in permanent visual acuity deficit. We present the case of a 29-year-old male recreational skier who traveled to a ski resort at 2930 m, ascended to 3470 m, and developed acute mountain sickness, high altitude pulmonary edema, and bilateral retinal hemorrhages. A funduscopic examination to determine if macular retinal hemorrhage is present may be performed by clinicians in the final assessment of patients following altitude illness.
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7/37. Conscientiousness and work performance while suffering from acute mountain sickness: a case report.

    A 52-yr-old male scientist who participated in a geophysical survey in Antarctica from a field camp located at 3538 m (11,600 ft) experienced specific symptoms of acute mountain sickness (AMS) by Mission Day 9, and full syndrome AMS by Mission Day 12. He was treated at the field camp and evacuated to sea level on the next available flight (Mission Day 15). The concerns of this highly conscientious individual that initial signs of illness, such as fatigue with exertion, could be misinterpreted by others as poor work performance are described. The report focuses on individual personality and group processes that could lead to nondisclosure of symptoms, and the need, particularly in long-duration missions in which evacuation is difficult or impossible, to sensitize personnel to the importance of recognizing and reporting potential health problems.
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8/37. Drug-induced hypoglycemia presenting as acute mountain sickness, after mistaking acetohexamide for acetazolamide.

    Acute mountain sickness (AMS) can present with a wide variety of symptoms in unacclimatized persons who rapidly ascend to altitudes > 2500 m. The clinical manifestations of drug-induced hypoglycemia, including adrenergic and neurologic symptoms, have significant overlap with the AMS symptom complex. These similarities can lead to confusion in the diagnosis of hypoglycemia versus AMS, particularly for diabetics ascending to altitude. A case is described in which the oral hypoglycemic agent acetohexamide, instead of acetazolamide, was mistakenly self-administered for the prophylaxis and treatment of altitude illness. Improper self-medication by travelers in remote areas may be more common than is currently recognized.
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9/37. Seizure and hemiparesis at high-altitude outside the setting of acute mountain sickness.

    Neurologic problems at high altitudes are well known. What is probably less emphasized are neurologic problems at altitude outside the setting of high-altitude cerebral edema. Because neurologic symptoms for these kinds of problems at high altitude are often transient, neuroradiologic scanning for these problems is usually not done or reported. Furthermore, diagnostic testing facilities may be unavailable in these remote high-altitude settings. A patient is described here with transient seizure and right-sided hemiparesis at high altitude with no preceding symptoms of acute mountain sickness. Computed tomography of the head was obtained in a hospital at lower altitude where the patient was taken promptly. The findings of the scan revealed probable focal cerebral edema in the left parietal lobe in keeping with his temporary right-sided weakness. Possible treatment modalities on the mountain for this problem are also discussed.
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10/37. delirium at high altitude.

    A 35-year-old man on a trek to the Mount Everest region of nepal presented with a sudden, acute confusional state at an altitude of about 5000 m. Although described at higher altitudes, delirium presenting alone has not been documented at 5000 m or at lower high altitudes. The differential diagnosis which includes acute mountain sickness and high altitude cerebral edema is discussed. Finally, the importance of travelling with a reliable partner and using proper insurance is emphasized in treks to the Himalayas.
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