Tuberous sclerosis in a military pilot.
Tuberous sclerosis (TS) is a multisystem disorder characterized by hamartomas in various organs. It usually manifests itself during infancy or childhood with neurological features, including mental retardation and seizures. We present the case of a military pilot who was diagnosed with TS at 22 yr. of age after he had completed flight training. Suspicion of TS arose from evaluation of a chronic rash around the pilot's nose, and diagnosis was confirmed based on the presence of multiple calcified nodules on CT imaging of the brain. No neurological abnormalities were found. The primary aeromedical concerns were the risk of seizures or development of tumors at sites that might lead to sudden incapacitation. Hamartomas can be reliably detected at an early stage by means of annual history, physical examination, and imaging of tumor-prone organs. After review of the literature and consultation with medical specialists, we assessed the risk of adult-onset seizures in a TS patient without preexisting neurological findings as scarce. The pilot was therefore granted a waiver limited to flying a two-pilot helicopter with a program of tight medical follow-up.
Wand
Ori
O
Aeromedical Center and Surgeon General Headquarters, Israeli Air Force, Tel-Hashomer, Israel. oriwand@hotmail.com
Blum
Shany
S
Shachar
Eyal
E
Azaria
Bela
B
Levite
Ronen
R
Assa
Amit
A
Barenboim
Erez
E
D000328:Adult; D000401:Aircraft; D001359:Aviation; D004827:Epilepsy / Q000209:etiology*; D006801:Humans; D007557:Israel; D008297:Male; D018570:Risk Assessment; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology