Characteristics of In-Flight Stroke

초록

Background: Atmospheric pressure decrease, relative hypoxia, low humidity and restricted motion take place during flight, and these environment change can precipitate the development of ischemic stroke through various mechanisms including paradoxical embolism by right-to-left shunt, dissection, and venous thrombosis. Previous reports estimated in-flight stroke or possible ischemic cerebral events up to 2 percent of total in-flight emergency. However, description of in-flight stroke case series has been limited until now. Here we report the clinical characteristics of in-flight stroke cases experienced in our hospital. Method: Since the opening of Incheon international airport in 2001, our hospital branch has been located at the airport and all the emergency stroke patients have been referred to our hospital. We performed retrospective review of the prospectively collected stroke registry from January 2001 to July 2014 and captured ischemic stroke which occurred during flight. Routine stroke work up including brain MRI and MR angiography, and etiologic investigation such as echocardiography was performed in all the patients. Results: During the study period, 14 in-flight stroke cases were identified among total 7705 ischemic stroke patients (9 men, 58±14.2 years old). Eleven patients had cerebral infarction, and two patients had transient ischemic attack with no lesion on diffusion weighted image. One patient was diagnosed as cerebral venous thrombosis. On etiological classification of cerebral infarction, 9 large artery atherothrombosis, 1 septic embolism, 1 cryptogenic stroke, and 1 multiple etiology (larger artery atherothrombosis with atrial fibrillation) were identified. Four patients were found to have symptomatic hemorrhagic transformation on initial brain image.