Traumatic carotid artery dissection during acrobatic flight associated with -G(z) acceleration.

BACKGROUND

A 38-yr-old man developed the acute onset of expressive aphasia and right hemiparesis during the performance of an advanced aerobatic flight maneuver.

CASE REPORT: Magnetic resonance imaging (MRI) demonstrated patchy infarction in the territory of the left middle cerebral artery. Magnetic resonance, angiography (MRA) revealed a dissection of the left internal carotid artery. He had flown an aerobatic routine with multiple abrupt transitions from +8 G(z) to -6 G(z) 4 d prior with no ill effects. He had no risk factors for dissection or stroke. The patient recovered full neurological function within several hours.

DISCUSSION: We propose that the arterial dissection occurred during the patient's preceding aerobatic flight, leading to an embolic stroke 4 d later. The most likely mechanism was sustained -G(z) acceleration combined with flexion and rotation of his neck during abrupt transition from +G(z) to -G(z), causing stretching of the internal carotid artery at the point of entry to the skull base and development of an intimal tear.