Ruptured arteriovenous anomaly in a former woman astronaut candidate

A case is reported of a former woman astronaut candidate who withstood the rigors of the preliminary physical examinations for this position. Some years later, she sustained a subarachnoid hemorrhage from an arteriovenous malformation in the right parieto-occipital area, which was successfully excised. Postoperatively, she had a marked visual deficit, from which she completely recovered within 3 months. The development of psychomotor seizures 5 months later was due to probable scarring in the right parieto-occipital region of the cerebral cortex, the interpretive area for orientation of body image in space, which had been supplied by the clipped right anterior and posterior cerebral arteries feeding the arteriovenous anomaly. These seizures have been well controlled on anticonvulsants. A lesion in the temporoparieto-occipital region due to a hemorrhage from a ruptured arteriovenous anomaly, resulting in the disabling symptoms of disorientation or loss of body image due to impairment of the interpretive cortex, could be devastating to the pilot and a mission. This case raises the question of an automatic use of the CT brain scan in screening potential space candidates, and even the consideration of a percutaneous femoral four-vessel arteriogram in all, or possibly selected, candidates. Most neurosurgeons and neuroradiologists probably would consider the risks of the latter procedure too great to justify its use for fear of permanent complications to the space candidate.