title: Traumatic carotid artery dissection during acrobatic flight associated with -G(z) acceleration.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street TMP3, New Haven, CT 06520, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Adler
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Ruskin
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
mesh_terms: D000328:Adult; D001359:Aviation; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D006112:Gravitation; D006801:Humans; D007899:Leisure Activities; D018810:Magnetic Resonance Angiography; D008297:Male; D009333:Neck; D012399:Rotation