First-ever Ischemic Stroke after a Flight in a Patient with Prior Poliomyelitis

Abstract

Survivors of poliomyelitis sometimes travel by air with mobility assistance. However, prolonged seating during long-haul flights may also possibly produce stroke events on polio-inflicted patients. A 48-year-old polio-inflicted male suffered a stroke after an extended flight. A two-dimensional echocardiography was normal without detected patent foramen ovale or dyskinetic segment. The venodynamic variables were all within normal limits. MR Imaging studies revealed acute cerebral infarction in the distribution of the right middle cerebral artery and posterior watershed area. Hematological examination revealed positive anti-cardiolipin IgG antibody which might contribute to the risk of thrombosis as an underlying condition in addition to immobilization. This is the first presentation of ischemic stroke after a flight in a patient with prior poliomyelitis. In addition to decompression sickness, economy class stroke syndrome and postpoliomyelitis syndrome, the physician should also take other coagulation disorders into consideration during the investigation.

Keywords: anticardiolipin antibodies; cabin pressurization; decompression sickness; dehydration; ischemic stroke; poliomyelitis.

Figure 1.

Imaging findings of the patient. Axial diffusion-weighted imaging (DWI) of brain MRI reveals several small acute infarcts involving the frontal and parietal lobes, right corona radiata and dorsal putamen shown with bright signal in the distribution of the right MCA territory and in the territories of the posterior watershed area compatible with the area of the apparent diffusion coefficient (ADC) reduction (a–d). The 3D time-offlight (TOF) MR angiography demonstrates abrupt disruption in mid-segment of M1 of right MCA (e). Long TR sequences demonstrate high signal abnormality centered in the right temporal, occipital, and middle frontal lobes suggesting old ischemia or infarct on the right cerebral hemisphere (f–h).

Figure 2.

Proposed pathophysiology of the stroke attack after prolonged flight in our case who was the patient of chronic poliomyelitis.