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Traumatic carotid artery dissection during acrobatic flight associated with -G(z) acceleration
Alexandra Adler1, Keith J Ruskin, David M Greer
1Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street TMP3, New Haven, CT 06520, USA.
Aviation, Space, and Environmental Medicine
|November 28, 2013
Summary
Aerobatic flight maneuvers, particularly those involving rapid G-force changes, may cause delayed internal carotid artery dissection and subsequent embolic stroke. This case highlights a potential risk for pilots undertaking high-performance flying.
Area of Science:
- Neurology
- Aerospace Medicine
- Vascular Surgery
Background:
- A 38-year-old male pilot experienced sudden expressive aphasia and right hemiparesis.
- Symptoms occurred during an advanced aerobatic flight maneuver.
Observation:
- Magnetic resonance imaging revealed infarction in the left middle cerebral artery territory.
- Magnetic resonance angiography identified a left internal carotid artery dissection.
- The patient had previously completed a demanding aerobatic routine without incident.
Findings:
- The stroke and arterial dissection were diagnosed 4 days after the aerobatic flight.
- No conventional risk factors for stroke or dissection were present.
- The patient made a complete neurological recovery within hours.
Implications:
- Proposes that sustained negative G-force acceleration (-Gz) combined with neck flexion/rotation during abrupt G-force transitions caused internal carotid artery intimal tear.
- Suggests a mechanism for delayed embolic stroke following high-performance aerobatic flight.
- Highlights the need for awareness of potential vascular injury in pilots exposed to extreme G-forces.
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