Leon-Velarde developed a score for the diagnosis of Chronic Mountain Sickness (CMS) based on clinical signs and symptoms as well as limited laboratory findings. Chronic Mountain Sickness occurs in persons living in the Andes and may present as a sensation of burning hands and/or feet.
Parameters:
(1) dizziness
(2) physical weakness
(3) mental fatigue
(4) anorexia
(5) muscle weakness
(6) joint pain
(7) breathlessness
(8) palpitations
(9) sleep disturbances
(10) cyanosis of lips, face or fingers
(11) injected conjunctivae
(12) dilatation of veins in the hands and/or feet
(13) paresthesias in the hands and/or feet
(14) headache
(15) tinnitus
(16) hemoglobin > 2 SD of controls at same altitude
(17) oxygen saturation < 2 SD of controls at same altitude
where:
• The definition of hemoglobin and oxygen saturation is a bit ambiguous. Since the normal range is defined as the mean +/- 2 or 2.5 SD, I will use the upper and lower limits of the normal reference range in the implementation.
|
Parameter |
Finding |
Points |
|---|---|---|
|
dizziness |
no |
0 |
|
|
yes |
1 |
|
physical weakness |
no |
0 |
|
|
yes |
1 |
|
mental fatigue |
no |
0 |
|
|
yes |
1 |
|
anorexia |
no |
0 |
|
|
yes |
1 |
|
muscle weakness |
no |
0 |
|
|
yes |
1 |
|
joint pain |
no |
0 |
|
|
yes |
1 |
|
breathlessness |
no |
0 |
|
|
yes |
2 |
|
palpitations |
no |
0 |
|
|
yes |
2 |
|
sleep disturbances |
no |
0 |
|
|
yes |
2 |
|
cyanosis of lips, face or fingers |
no |
0 |
|
|
yes |
2 |
|
injected conjunctivae |
no |
0 |
|
|
yes |
2 |
|
dilatation of veins in the hands and feet |
no |
0 |
|
|
yes |
2 |
|
paresthesias in hands and/or feet |
no |
0 |
|
|
yes |
2 |
|
headache |
no |
0 |
|
|
yes |
3 |
|
tinnitus |
no |
0 |
|
|
yes |
3 |
|
hemoglobin |
<= 2 SD above mean |
0 |
|
|
> 2 SD above mean |
3 |
|
oxygen saturation |
>= 2 SD below mean |
0 |
|
|
< 2 SD below mean |
3 |
total score =
= SUM(points for all 17 parameters)
Interpretation:
• minimum score: 0
• maximum score: 32
• The higher the score the more severe the CMS.
|
Total Score |
Interpretation |
|---|---|
|
0 to 12 |
normal |
|
13 to 18 |
mild |
|
19 to 24 |
moderate |
|
25 to 32 |
severe |
Table 1, page 1533, Appenzeller et al (2002)
where:
• In Appenzeller et al, the range for normal is <= 12 and for mild is 12-18. I set the cut-offs above to prevent overlap.
Purpose: To evaluate a person for findings associated with chronic mountain sickness using the score of Leon-Velarde.
Specialty: Emergency Medicine, Critical Care, Pulmonology, Neurology
Objective: clinical diagnosis, including family history for genetics, severity, prognosis, stage
ICD-10: W94, T70,
