Soroxchi after Traveling to South America: Cognitive and Neurobehavioral Changes in a Patient with Bilateral Globus Pallidus Lesions

Abstract

Objective Soroxchi/Acute Mountain Sickness (AMS) is a condition that can result in cerebral and pulmonary hypoxia. Neuropsychological research on AMS is minimal and the long-term effects on cognition and behavior are unclear. AMS is associated with cognitive impairments in processing speed, attention, and executive functions as well as neurobehavioral symptoms. This case study delineates the neuropsychological and neurobehavioral changes secondary to bilateral globus pallidus (GP) lesions associated with AMS. Case Description Patient is a 51-year old, primarily Spanish-speaking, male of Mexican descent with 9 years of education, and who had traveled to La Paz, Bolivia (4,070 MASL) for work. Upon arrival, fatigue and dizziness led to hospitalization to treat acute pulmonary edema and hypoxia. Brain MRI revealed hyperintense bilateral GP lesions. Medical history was notable for hyperlipidemia. Psychiatric history was unremarkable. Neuropsychological assessment 4 months post-AMS revealed impairments in visuo-conceptual and speeded complex visuospatial abilities, executive functions, and confrontation naming. Cognitive improvements were noted in delayed recall of non-contextual verbal information and confrontation naming ten months post-AMS. Significant mood and personality changes were reported; patient endorsed anhedonia, fatigue, alexithymia, avolition, and sleep difficulties. Family described patient as depressed, apathetic, and socially withdrawn. Pharmacological and psychotherapy treatments were recommended and initiated. Diagnostic Impressions and Outcomes Findings were consistent with a diagnosis of Mild Neurocognitive Disorder. His family denied neurobehavioral improvements post interventions. Discussion This case study is the first to characterize the long-term neuropsychological and neurobehavioral changes following bilateral GP lesions secondary to AMS. Declines in visual-conceptual abilities reveal a new finding for this type of cerebral incident.