The incidence of severe symptoms of altitude illness among recreational climbers has reached 9%, of which 1% requires hospital treatment. ¹ Dexamethasone is the mainstay of pharmacological intervention in moderate-to-severe acute mountain sickness (AMS) and high-altitude cerebral oedema (HACE). It can be life-saving when immediate descent and oxygen therapy are not feasible. Although the mechanism by which dexamethasone exerts its therapeutic effects in the setting of AMS and HACE treatment remains unclear, it probably serves to ameliorate vasogenic oedema through the stabilization of the blood–brain barrier and the attenuation of anti-inflammatory responses. ² Dexamethasone can be administered intravenously, intramuscularly or orally. Its administration should include a loading dose of 8 mg (HACE), followed by a 4 mg dose every 6 h (AMS and HACE). ² Symptoms, such as nausea and vomiting, are common in AMS and HACE and impaired consciousness predominating in HACE precludes the oral administration of dexamethasone. Intravenous drug administration by climbers who are not medics is practically impossible. Intramuscular route can be used by climbers but requires training. As a result, a significant proportion of AMS and HACE patients cannot benefit from dexamethasone treatment under real conditions.

Visual sensations appear in most migraine auras, but binocular blindness is uncommon. We described a case of multiple transient losses of vision in a man on a winter expedition to K2. His symptoms were later diagnosed as recurrent visual auras without pain. Sojourns at altitude can induce migraine attack; therefore, susceptible individuals should avoid factors that might provoke migraines at high altitude, such as improper acclimatization, dehydration and an inadequate sleep regime.

Spinocerebellar ataxias are rare, genetically inherited diseases. Their typical symptoms include disturbances in gait, balance and uncoordinated movements, but these abnormalities, when appear at altitude, might also suggest high-altitude cerebral edema. We described the first clinical manifestation of spinocerebellar ataxia of a climber from Poland on a Karakoram expedition.