The high-altitude brain

SUMMARY The highest place on our planet, Mount Everest (8850m), appears to be close to the limit of how high an acclimatized human can go, albeit slowly. In this paper, I will explore the possibility that what limits human performance at such extreme degrees of hypoxia is the availability of oxygen to the brain. Also, one of the known costs of such extreme exposure is residual mild impairment of performance on neuropsychometric tests after return to sea level, implying injury to brain cells. That such injury could occur in the absence of any overt impairment of function, much less without loss of consciousness, is unexpected. I will speculate about physiological mechanisms that might cause or contribute to both decrements in real-time performance while at altitude and residual deficits for a time after return to low elevations; the effects of hypoxia on brain cells are an even greater puzzle at the present time.