Subtle Cognitive Dysfunction in Resolving High Altitude Cerebral Edema Revealed by a Clock Drawing Test

Area of Science:

• Altitude sickness
• Neurology
• Emergency medicine

Background:

• High altitude cerebral edema (HACE) is a severe condition affecting individuals above 2500m.
• HACE is differentiated from acute mountain sickness (AMS) by altered mental status and ataxia.

Observation:

• A patient presented with subtle cognitive dysfunction, suspected to be unresolved HACE.
• Initial assessment revealed normal mental status and no ataxia, leading to a missed HACE diagnosis.
• Further history and a clock drawing test confirmed cognitive impairment.

Findings:

• The clock drawing test identified cognitive dysfunction not apparent during a standard mental status examination.
• Subtle cognitive deficits can indicate HACE even without overt neurological signs like ataxia.

Implications:

• A formal mental status examination, including a clock drawing test, is recommended for high-altitude travelers.
• Early HACE diagnosis is crucial, even with seemingly normal neurological exams.
• This approach can improve HACE detection and patient outcomes at high altitudes.