Here we report a case of ischemic stroke in a 55-year-old man climbing a mountain 2400m above see level alone who successfully recovered after treatment with reperfusion therapy. He experienced an ischemic stroke on a snowfield at an altitude of 2400m while climbing the 3180m Mt. Yarigatake in May. A nearby climber reported the incident by cellular phone. The patient was rescued by a Nagano Prefecture Emergency Management Air Corps helicopter and transported to our hospital 1 h after stroke onset. On arrival, his National Institutes of Health Stroke Scale (NIHSS) score was 25. At 2 h 9 min after onset, the recombinant tissue plasminogen activator alteplase was administered intravenously and his NIHSS score improved to 2. The patient was transferred to another hospital on day 19 after onset with a modified Rankin Scale score of 2 and a Barthel Index score of 100. He returned to work 78 days after onset. This is the first case report in Japan about the successful treatment of cerebral infarction that occurred on a mountain at 2400m. While good weather and various other favorable conditions helped to improve the patient’s prognosis, other factors, such as the good communication infrastructure and the coordination between the aeromedical service system and hospital, played a major role in mountain rescue of this patient.

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