Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.
This week, our hypothetical patient is a 30-year-old female who traveled from her home in the Black Hills to hike around Denali National Park and Preserve in Alaska. While there, she decided to hike the centerpiece of the park, Denali (formerly known as Mount McKinley). This is the highest mountain peak in North America with a summit at 20,310 ft above sea level. As she made her ascent, she started to experience increasingly severe headaches. She had trouble sleeping along the way and started feeling nauseous, which led to her eating less and less as she traveled. When she reached 14,000 ft, she stopped at the medical camp on the mountain to see a doctor about her symptoms. Upon physical examination, her lungs were clear to auscultation, her neurological exam was normal, and her oxygen saturation was at 84% while breathing ambient air (which is normal). The doctor recommended for her to consider descending, but she refused. She agreed to stay at the camp overnight and was given acetaminophen for her headaches and anti-emetics for her nausea. The doctor also gave her Diamox to take twice a day to help her acclimatize. After a few days, she was forced to stop at the 17,000 ft medical camp because she was having trouble walking and her headache was worse despite the medication. She also reports having vomited a few times before stopping at the camp. The doctor at the 17,000 ft medical camp gave her dexamethasone and ordered her to descend and to be admitted to the hospital.
Thought Questions:
This week, our hypothetical patient is a 30-year-old female who traveled from her home in the Black Hills to hike around Denali National Park and Preserve in Alaska. While there, she decided to hike the centerpiece of the park, Denali (formerly known as Mount McKinley). This is the highest mountain peak in North America with a summit at 20,310 ft above sea level. As she made her ascent, she started to experience increasingly severe headaches. She had trouble sleeping along the way and started feeling nauseous, which led to her eating less and less as she traveled. When she reached 14,000 ft, she stopped at the medical camp on the mountain to see a doctor about her symptoms. Upon physical examination, her lungs were clear to auscultation, her neurological exam was normal, and her oxygen saturation was at 84% while breathing ambient air (which is normal). The doctor recommended for her to consider descending, but she refused. She agreed to stay at the camp overnight and was given acetaminophen for her headaches and anti-emetics for her nausea. The doctor also gave her Diamox to take twice a day to help her acclimatize. After a few days, she was forced to stop at the 17,000 ft medical camp because she was having trouble walking and her headache was worse despite the medication. She also reports having vomited a few times before stopping at the camp. The doctor at the 17,000 ft medical camp gave her dexamethasone and ordered her to descend and to be admitted to the hospital.Thought Questions:
What is the most likely diagnosis for this patient?
Which diagnostic tests would confirm this diagnosis?
What are the anatomical structures involved in this clinical issue?
What are the potential underlying causes for this condition?
What is a good recommended course of treatment for our hypothetical patient?
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