title: Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema Revealed by a Clock Drawing Test.
abstract: High altitude cerebral edema (HACE) is a life-threatening condition that can affect people who ascend to altitudes above 2500 m. Altered mental status and the presence of ataxia distinguishes HACE from acute mountain sickness (AMS). We describe a patient with subtle cognitive dysfunction, likely due to HACE that had not fully resolved. When he initially presented, the patient appeared to have normal mental status and was not ataxic. The diagnosis of HACE was missed initially but was made when further history became available. Cognitive dysfunction was then diagnosed based on abnormal performance of a clock drawing test. A formal mental status examination, using a clock drawing test, may be helpful in assessing whether a patient at high altitude with apparently normal mental status and with normal gait has HACE.
authors.affiliation: Western Road Medical Centre, Romford, United Kingdom (Dr Quigley).
authors.forename: Ian
authors.initials: I
authors.lastname: Quigley
authors.affiliation: Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK; Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA; Himalayan Rescue Association, Kathmandu, Nepal (Dr Zafren). Electronic address: kenzafren@gmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Zafren
mesh_terms: D000532:Altitude Sickness / Q000503:physiopathology* / Q000628:therapy; D001929:Brain Edema / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D009390:Nepal
keywords: acute mountain sickness; altitude sickness; clock drawing test; high altitude cerebral edema; high altitude pulmonary edema; hypoxia