Basnyat B
Medical Director, Himalayan Rescue Association and Nepal International Clinic, Medical Attending, Patan Hospital, Lal Durbar, Kathmandu, Nepal.
J Travel Med. 1998 Dec;5(4):221-2. doi: 10.1111/j.1708-8305.1998.tb00512.x.
A 35-year-old healthy Dutch woman went on a trek (Lang Tang) in Nepal up to an approximate altitude of about 3800 meters. She had no prior history of any medical problems except attacks of generalized epilepsy when she was 19 years old, which had been controlled with antiepileptic medications. She had had no attacks after the age of 20. A CT scan done around that time had apparently been normal. On this trek she had developed diarrhea which had been cured with norfloxacin 400 mg two times per day for 3 days. Two days later, while descending, she developed a grand mal seizure at an altitude of 3300 meters, after which she developed a classic postictal phase but gradually recovered. She developed grand mal seizures again the next day, but when she went to a travel clinic in Kathmandu, she had been seizure free for 72 hours. She also revealed that she had not suffered from acute mountain sickness on the trek. She also had a prior history of gastroenteritis at high altitude which improved significantly with norfloxacin, a quinolone antibiotic. This was corroborated by her party. Upon examination she was fully conscious and oriented to person, place and time. Her pulse was 70 beats per minute and her BP was 110/80 mm of Hg. Her fundi and cranial nerves exam were completely normal. Her abstract thinking, gait, power, tone, reflexes and other facets of her neurologic exam revealed absolutely no abnormalities. Her cardiovascular exam revealed a normal rhythm with no murmurs or bruits. The rest of her exam was also normal. She revealed that she played tennis on a regular basis and was an outdoor person. She had not trekked before in the Himalayas and it was uncertain if she had been to high altitude before. She was on no medications at the time. There was no history of drug abuse. She did not smoke and consumed few alcoholic beverages. She had not consumed any alcohol on the trek. She was advised to get a CT scan (she declined as she was going home to Holland in 2 days) and she was prescribed a loading dose of phenytoin 1 g orally spread over several hours and it was recommended she take 300 mg of phenytoin per day. She was going to see her neurologist in Holland on arrival there. She went to her hotel in Kathmandu while her friends went to fill the prescription of phenytoin. When her friends returned to the hotel she was having another grand mal seizure. Medical help was sought, but she died before the doctor arrived to control her seizures. When the doctor did arrive and carried out CPR for half an hour it was to no avail as she continued to have no pulse or blood pressure.
一名35岁健康的荷兰女性前往尼泊尔进行徒步旅行（朗塘谷徒步），到达了海拔约3800米的高度。她既往没有任何医疗问题史，仅在19岁时发作过全身性癫痫，通过抗癫痫药物已得到控制。20岁以后她就没有再发作过。当时做的CT扫描显然是正常的。在这次徒步旅行中，她出现了腹泻，每天服用两次400毫克诺氟沙星，持续3天，腹泻得以治愈。两天后，在下山途中，她于海拔3300米处发生了一次癫痫大发作，之后进入典型的发作后阶段，但逐渐恢复。第二天她又发作了癫痫大发作，但当她前往加德满都的一家旅行诊所时，她已经72小时没有发作了。她还透露，在徒步旅行中她没有患急性高山病。她既往有过在高海拔地区患肠胃炎的病史，使用喹诺酮类抗生素诺氟沙星后病情明显好转。这一点得到了她同行人员的证实。经检查，她意识完全清醒，对人物、地点和时间定向正常。她的脉搏为每分钟70次，血压为110/80毫米汞柱。她的眼底和颅神经检查完全正常。她的抽象思维、步态、肌力、肌张力、反射及其他神经系统检查方面均未发现任何异常。她的心血管检查显示心律正常，无杂音或血管杂音。她的其他检查也正常。她透露自己经常打网球，是个喜欢户外活动的人。她以前没有在喜马拉雅山脉徒步旅行过，也不确定她以前是否去过高原地区。当时她没有服用任何药物。没有药物滥用史。她不吸烟，很少饮酒。在徒步旅行中她没有喝过任何酒。建议她做CT扫描（她拒绝了，因为她两天后就要回荷兰了），并给她开了一剂负荷量的苯妥英钠，口服1克，分几个小时服用，并建议她每天服用300毫克苯妥英钠。她到达荷兰后要去看她的神经科医生。她回到加德满都的酒店，而她的朋友们去取苯妥英钠的处方。当她的朋友们回到酒店时，她又发作了一次癫痫大发作。寻求了医疗帮助，但在医生赶来控制她的癫痫发作之前她就去世了。当医生赶到并进行了半小时的心肺复苏时，已无济于事，因为她仍然没有脉搏和血压。
