Hyperintense white matter lesions in 50 high-altitude pilots with neurologic decompression sickness

Stephen A. McGuire, Paul M. Sherman, Anthony C. Brown, Andrew Y. Robinson, David F. Tate, Peter T. Fox, Peter V. Kochunov

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Introduction: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1117-1122
Number of pages6
JournalAviation Space and Environmental Medicine
Issue number12
StatePublished - 2012


  • High altitude
  • Hyperintense white matter lesions
  • Neurocognitive impairment
  • Neurologic decompression sickness
  • U-2 pilot

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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