Ruptured arteriovenous anomaly in a former woman astronaut candidate

Area of Science:

• Neurology
• Aerospace Medicine
• Neurosurgery

Background:

• Astronaut candidates undergo rigorous physical examinations.
• Arteriovenous malformations (AVMs) are congenital abnormalities of blood vessels.
• Subarachnoid hemorrhage (SAH) is a serious type of stroke.

Observation:

• A former astronaut candidate with a history of passing preliminary physicals developed a subarachnoid hemorrhage from a right parieto-occipital arteriovenous malformation.
• The AVM was surgically excised, initially resulting in a significant visual deficit that resolved within three months.
• Five months post-surgery, the patient developed psychomotor seizures attributed to cortical scarring in the brain's spatial orientation area.

Findings:

• The patient's seizures were successfully managed with anticonvulsant medication.
• The case illustrates how temporoparieto-occipital lesions from ruptured AVMs can cause disorientation and loss of body image, posing risks to pilots and missions.
• This scenario prompts consideration of enhanced neuroimaging screening for spaceflight candidates.

Implications:

• The case questions the routine use of computed tomography (CT) brain scans for screening potential astronauts.
• It also raises the debate about performing percutaneous femoral four-vessel arteriograms on selected or all candidates.
• However, the inherent risks associated with arteriography may outweigh the benefits for routine screening in space candidates.