Parkinsonism after climbing high amplitude mountain: a case report

Abstract

Acute mountain sickness (AMS) is caused by climbing to a high altitude above 2,500 meters without acclimatization. Various clinical symptoms of AMS include headache, nausea, malaise, dizziness, and insomnia within 6 to 12 hours after reaching the high altitude. Neurological consequences like Parkinsonism following AMS without lesion of brain MRI have been reported rarely. A healthy 64-year-old man presented with gait disturbance. Neurological examination showed tremor of hands, limb rigidity, and bradykinesia. He had never climbed above 1,500 m before. Symptoms developed about 20 days after he had been climbing in the Baekdu Mountain up to 2,700 meters. Neurologic examination showed mental alertness and Unified Parkinson’s Disease Rating Scale (UPDRS) part III(Motor examination) was checked 10 points by rating resting tremor of his hands(2), limb rigidity(4), gait(2) and bradykinesia(finger tapping 1, toe tapping 1). Routine laboratory examinations were normal in blood tests. His electrocardiogram and echocardiography were normal, and there were no lesions detected in the brain MRI including T2-weighed and FLAIR image. He was almost improved after parkinsonism persisted for about five months. We presume that Parkinsonism occurred by transient regional hypometabolism due to hypoxia in both globus pallidus although we did not perform functional imaging. We suggest that Parkinsonism can develop after climbing to a high altitude but they can be transient symptoms in case of no abnormalities on brain MRI. Additionally, people who plan to climb high altitudes above 2,500 m need sufficient acclimatization before climbing and must pay attention to speed of ascent. Acute mountain sickness (AMS) is caused by climbing to a high altitude above 2,500 meters without acclimatization. Various clinical symptoms of AMS include headache, nausea, malaise, dizziness, and insomnia within 6 to 12 hours after reaching the high altitude. Neurological consequences like Parkinsonism following AMS without lesion of brain MRI have been reported rarely. A healthy 64-year-old man presented with gait disturbance. Neurological examination showed tremor of hands, limb rigidity, and bradykinesia. He had never climbed above 1,500 m before. Symptoms developed about 20 days after he had been climbing in the Baekdu Mountain up to 2,700 meters. Neurologic examination showed mental alertness and Unified Parkinson’s Disease Rating Scale (UPDRS) part III(Motor examination) was checked 10 points by rating resting tremor of his hands(2), limb rigidity(4), gait(2) and bradykinesia(finger tapping 1, toe tapping 1). Routine laboratory examinations were normal in blood tests. His electrocardiogram and echocardiography were normal, and there were no lesions detected in the brain MRI including T2-weighed and FLAIR image. He was almost improved after parkinsonism persisted for about five months. We presume that Parkinsonism occurred by transient regional hypometabolism due to hypoxia in both globus pallidus although we did not perform functional imaging. We suggest that Parkinsonism can develop after climbing to a high altitude but they can be transient symptoms in case of no abnormalities on brain MRI. Additionally, people who plan to climb high altitudes above 2,500 m need sufficient acclimatization before climbing and must pay attention to speed of ascent.