Hysterical Conversion Disorder in a Young Girl at Moderate Altitude

Abstract

Case report A 10-year-old girl hiked with other members of her group to a summit at a height of 2400 m in Switzerland. They left in the morning from their residence altitude of 600 m, were dropped off with a 4-wheel-drive car at a shelter at 1400 m, and started to hike from this point. During the ascent and after 2 hours of walking, the young girl complained of a headache and a sensation of oppression, but she reached the top together with the rest of the group. The group spent 1 hour having lunch on the summit. After lunch, her headache and her sensation of being unable to take a deep breath were exacerbated, and she became ataxic and unable to stand up; yet she did not lose consciousness. She was carried by several adults and brought down to a shelter at 1400 m after a lapse of 3 hours without improvement of her symptoms. The accompanying adults were in a hurry, and a call for help was sent out. The medical team arrived within 20 minutes by helicopter due to the inaccessibility of the shelter. The helicopter’s physician noticed that the patient was conscious, with no sensory or motor deficiency; the pupils and osteotendinous reflexes were normal. She presented dyskinetic movement of both arms and slight dysarthria, and she spoke in a hushed voice; she was completely unable to stand up (falling backward with exaggerated movements) and also had a tendency to somnolence. Arterial pressure, heart rate, respiratory rate, temperature, and oxygen saturation were all normal, yet her intense headache and her sensation of being unable to get enough air were persistent symptoms. Quite strikingly, she appeared to be completely indifferent and did not ask for any explanations about her clinical condition. She did not report any medical history. At the shelter, oxygen was administered, and an intravenous line was inserted. She was thereafter transported to the