title: Irreversible subcortical dementia following high altitude illness.
abstract: In this report, we present the cases of two 63-year-old women who developed high altitude cerebral edema complicated by the occurrence of permanent neuropsychiatric sequelae. They shared a similar clinical course, in that both developed disturbance of consciousness shortly after their arrival at Cuzco, Peru (3500 m), and both developed persistent neuropsychiatric symptoms after resolution of the acute illness. Interestingly, in case 2 there was a 1-month lucid interval between remission of high altitude illness and occurrence of the irreversible neuropsychiatric sequelae. Brain computerized tomography in case 1 and brain magnetic resonance imaging in case 2 disclosed lesions in the globus pallidus bilaterally, suggesting that the neuropsychiatric symptoms in these patients were manifestations of subcortical dementia. The development of high altitude illness was considered to be attributable to mild restrictive lung impairment in case 1 and to a deficient ventilatory response to hypoxia in case 2. It must therefore be borne in mind that irreversible subcortical dementia may be associated with high altitude cerebral edema.
authors.affiliation: Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan. chiec@med.juntendo.ac.jp
authors.forename: Chie
authors.initials: C
authors.lastname: Usui
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Inoue
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kimura
authors.forename: Eiji
authors.initials: E
authors.lastname: Kirino
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nagaoka
authors.forename: Michirou
authors.initials: M
authors.lastname: Abe
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nagata
authors.forename: Heii
authors.initials: H
authors.lastname: Arai
mesh_terms: D000208:Acute Disease; D000532:Altitude Sickness / Q000150:complications* / Q000503:physiopathology*; D001929:Brain Edema / Q000150:complications* / Q000209:etiology; D015140:Dementia, Vascular / Q000209:etiology* / Q000473:pathology; D005260:Female; D005917:Globus Pallidus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed