Stroke in Commercial Flights

Abstract

Background and Purpose— Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. Methods— A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Results— Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. Conclusions— We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis.

Changes in Heart Rate and Rhythm During a Crossover Study of Simulated Commercial Flight in Older and Vulnerable Participants

“…Reduced HRV and increased HR are predictive of acute and chronic cardiovascular morbidity and mortality (Tsuji et al, 1996; Nolan et al, 1998; Perret-Guillaume et al, 2009). Flight, simulated flight, and flight-related environmental exposures are related to changes in HR and HRV as well as to cardiovascular events in previous studies (Jorna, 1993; Sauvet et al, 2009; Alvarez-Velasco et al, 2016). We hypothesized that we would observe associations between simulated flight conditions and unfavorable changes in HR and markers of HRV in a vulnerable population, and investigated this possibility in a crossover, single-blinded chamber exposure study.…”

Emerging Stroke Risk Factors: A Focus on Infectious and Environmental Determinants

“…They also noted a higher frequency of high-grade carotid stenosis and occlusion in their cohort (12 patients, 27%). Furthermore, 67% of the strokes linked to high-grade carotid stenosis or occlusion occurred on longer flights (>4 h) [90]. It is hypothesized that in individuals with already compromised carotid perfusion, the combination of dehydration and a decrease in cabin air pressure leading to hypoxemia may increase the risk of stroke [90].…”

Pre-travel Health Advice for Patients With Cardiovascular Disease

“…14 Additionally, the use of in-flight supplemental oxygen is also recommended for these travellers. In contrast to the dearth of literature on air travel in stroke patients, there is abundant literature that describes in-flight and post-flight stroke incidence [15][16][17] as well as repatriation due to CVA abroad. 18,19 Congenital Heart Disease The literature on congenital heart disease (CGHD) and air travel is limited.…”