Prospective Study of White Matter Health for an Altitude Chamber Research Program

INTRODUCTION: Hypobaric decompression has been associated with brain white matter injury. Relevant exposure limits are unknown, raising ethical concerns over safety of volunteers for altitude chamber research. To inform this, a prospective study of white matter status using brain Magnetic Resonance Imaging (MRI) was conducted before and after a 9-mo program of hypobaric research.METHODS: Volunteers underwent 3-D, volumetric, fluid attenuated inversion recovery (FLAIR) MRI at the University of Nottingham, UK, on study entry and again after their final exposure. MRI data were analyzed and reported independently at the University of Maryland, Baltimore, MD, USA. Entry criteria were 5 subcortical white matter hyperintensities (WMH) of total volume 0.08 mL.RESULTS: One volunteer failed screening with 63 WMH (total volume 2.38 mL). Eleven individuals completed 160 short-duration (< 1h) exposures (range 3 to 26) to 18,000 ft pressure altitude (maximum 40,000 ft), no more often than twice weekly. The cohort exhibited eight total WMH on study entry (total volume 0.166 mL) and five (mostly different) total WMH on exit (0.184 mL). Just one WMH (frontal lobe) was present on both entry and exit scans. Excess background WMH on MRI screening were associated with past mild traumatic brain injury (MTBI).CONCLUSIONS: One hypoxia familiarization plus multiple, brief, infrequent, nonhypoxic hypobaric exposures (with denitrogenation) have not promoted WMH in this small cohort. Less intensive programs of decompression stress do not warrant MRI screening. A negative past history of MTBI has strong negative predictive value for excess WMH in young healthy subjects (N 33).Connolly DM, Lupa HT.