Stroke in the young aviator.

A robustly healthy aviator experienced a sudden focal impairment in cerebral function from which he rapidly recovered in a manner consistent with the entity known as "spectacular shrinking deficit syndrome." Although brain imaging studies revealed a "lacunar" type lesion involving the caudate nucleus, the clinical picture was much more suggestive of a cardiogenic embolic event. Transthoracic echocardiography was required to demonstrate the probable cause of the stroke (an atrial septal defect). Following surgical repair of the atrial septal defect, the aviator was recommended for waiver to resume duties involving aviation as pilot in command.