title: Hyperintense white matter lesions in 50 high-altitude pilots with neurologic decompression sickness.
abstract: BACKGROUND
  Neurologic decompression sickness (NDCS) can affect high-altitude pilots, causing variable central nervous system symptoms. Five recent severe episodes prompted further investigation.
  
  
  METHODS
  We report the hyperintense white matter (HWM) lesion imaging findings in 50 U-2 pilot volunteers, and compare 12 U-2 pilots who experienced clinical NDCS to 38 U-2 pilots who did not. The imaging data were collected using a 3T magnetic resonance imaging scanner and high-resolution (1-mm isotropic) three-dimensional fluid-attenuated inversion recovery sequence. Whole-brain and regional lesion volume and number were compared between groups.
  
  
  RESULTS
  The NDCS group had significantly increased whole brain and insular volumes of HWM lesions. The intergroup difference in lesion numbers was not significant.
  
  
  CONCLUSIONS
  A clinical episode of NDCS was associated with a significant increase in HWM lesion volume, especially in the insula. We postulate this to be due to hypobaric exposure rather than hypoxia since all pilots were maintained on 100% oxygen throughout the flight. Further studies will be necessary to better understand the pathophysiology underlying these lesions.
authors: U.S. Air Force School of Aerospace Medicine, Aerospace Medicine Consultation Division, Wright-Patterson AFB, OH, USA. smcguire@satx.rr.com
authors: Stephen A
authors: SA
authors: McGuire
authors: Paul M
authors: PM
authors: Sherman
authors: Anthony C
authors: AC
authors: Brown
authors: Andrew Y
authors: AY
authors: Robinson
authors: David F
authors: DF
authors: Tate
authors: Peter T
authors: PT
authors: Fox
authors: Peter V
authors: PV
authors: Kochunov
mesh_terms: D000328:Adult; D000401:Aircraft; D000531:Altitude; D001921:Brain / Q000473:pathology*; D003665:Decompression Sickness / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D018709:Statistics, Nonparametric