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Abstract Details

Can she ever fly again? A curious case of a PICA infarct in a healthy woman at high altitude and a review of known cerebrovascular changes at high elevations
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (11:45 AM-12:45 PM)
13-005

- Report a case of a healthy patient who endured a PICA infarction at high altitude

- Review known cerebrovascular changes that occur at high altitude to include hypoxemia, autoregulation and arrhythmias

High altitude exposure results in multiple compensatory responses, though cerebrovascular changes remains incompletely understood. Physiologic responses to hypoxemia and global changes in cerebral blood flow (CBF) that evolve during the course of high altitude exposure may result in alterations of cerebral peri-lesional blood flow. Additionally, several small case series have suggested an increased risk of arrhythmias such as atrial fibrillation at high altitude. For these reasons, determining the etiology of stroke in the setting of high altitude can be a challenge for the clinical neurologist.

N/A
We present a case of a 53 year-old otherwise healthy female who developed acute onset vertigo, dysphagia, and cross body sensory changes while exerting herself at 9,000 feet above sea level. Three days after symptoms, she presented to a large military medical center near her home at sea level and was found to have a right V4 vertebral artery filling defect on CTA and an acute right PICA infarction on MRI. Prolonged ambulatory monitoring at sea level showed no atrial fibrillation/flutter and follow-up imaging showed resolution of V4 filling defect. In preventing recurrent stroke, the patient’s primary question was whether she should avoid commercial air travel.

Compensatory responses to extreme environments may impact stroke risk and should be considered when determining stroke etiology. We report a case of PICA infarction in an otherwise healthy patient with exposure to high altitude. The hypothesized etiologies include (1) impaired peri-lesion CBF in the setting of compensatory hypoxemic tachypnea and cerebral autoregulation and/or (2) paroxysmal atrial fibrillation precipitated by hypoxemia. We also provide a clinically relevant review of compensatory cerebrovascular changes at high altitude for the practicing neurologist.  

Authors/Disclosures
William Hoffman, MD (United States Air Force)
PRESENTER
The institution of Dr. Hoffman has received research support from United States Air Force. Dr. Hoffman has a non-compensated relationship as a Member with United States Air Force that is relevant to AAN interests or activities.