Abstract
Objective: To demonstrate that U-2 pilot occupational exposure to hypobaria leads to increased incidence of white matter hyperintensities (WMH) with a more uniform distribution throughout the brain irrespective of clinical neurologic decompression sickness history. Methods: We evaluated imaging findings in 102 U-2 pilots and 91 controls matched for age, health, and education levels. Three-dimensional, T2-weighted, high-resolution (1-mm isotropic) imaging data were collected using fluid-attenuated inversion recovery sequence on a 3-tesla MRI scanner. Whole-brain and regionalWMHvolume and number were compared between groups using a 2-tailed Wilcoxon rank sum test. Results: U-2 pilots demonstrated an increase in volume (394%; p 5 0.004) and number (295%; p, 0.001) ofWMH. Analysis of regional distribution demonstratedWMH more uniformly distributed throughout the brain in U-2 pilots compared with mainly frontal distribution in controls. Conclusion: Pilots with occupational exposure to hypobaria showed a significant increase inWMH lesion volume and number. Unlike the healthy controls with predominantly WMH in the frontal white matter, WMH in pilots were more uniformly distributed throughout the brain. This is consistent with our hypothesized pattern of damage produced by interaction between microemboli and cerebral tissue, leading to thrombosis, coagulation, inflammation, and/or activation of innate immune response, although further studies will be necessary to clarify the pathologic mechanisms responsible.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 729-735 |
| Number of pages | 7 |
| Journal | Neurology |
| Volume | 81 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 20 2013 |
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ASJC Scopus subject areas
- Clinical Neurology
- Arts and Humanities (miscellaneous)
Cite this
White matter hyperintensities on MRI in high-altitude U-2 pilots. / McGuire, Stephen; Sherman, Paul; Profenna, Leonardo; Grogan, Patrick; Sladky, John; Brown, Anthony; Robinson, Andrew; Rowland, Laura; Hong, Elliot; Patel, Beenish; Tate, David; Kawano, Elaine S.; Fox, Peter T; Kochunov, Peter.
In: Neurology, Vol. 81, No. 8, 20.08.2013, p. 729-735.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - White matter hyperintensities on MRI in high-altitude U-2 pilots
AU - McGuire, Stephen
AU - Sherman, Paul
AU - Profenna, Leonardo
AU - Grogan, Patrick
AU - Sladky, John
AU - Brown, Anthony
AU - Robinson, Andrew
AU - Rowland, Laura
AU - Hong, Elliot
AU - Patel, Beenish
AU - Tate, David
AU - Kawano, Elaine S.
AU - Fox, Peter T
AU - Kochunov, Peter
PY - 2013/8/20
Y1 - 2013/8/20
N2 - Objective: To demonstrate that U-2 pilot occupational exposure to hypobaria leads to increased incidence of white matter hyperintensities (WMH) with a more uniform distribution throughout the brain irrespective of clinical neurologic decompression sickness history. Methods: We evaluated imaging findings in 102 U-2 pilots and 91 controls matched for age, health, and education levels. Three-dimensional, T2-weighted, high-resolution (1-mm isotropic) imaging data were collected using fluid-attenuated inversion recovery sequence on a 3-tesla MRI scanner. Whole-brain and regionalWMHvolume and number were compared between groups using a 2-tailed Wilcoxon rank sum test. Results: U-2 pilots demonstrated an increase in volume (394%; p 5 0.004) and number (295%; p, 0.001) ofWMH. Analysis of regional distribution demonstratedWMH more uniformly distributed throughout the brain in U-2 pilots compared with mainly frontal distribution in controls. Conclusion: Pilots with occupational exposure to hypobaria showed a significant increase inWMH lesion volume and number. Unlike the healthy controls with predominantly WMH in the frontal white matter, WMH in pilots were more uniformly distributed throughout the brain. This is consistent with our hypothesized pattern of damage produced by interaction between microemboli and cerebral tissue, leading to thrombosis, coagulation, inflammation, and/or activation of innate immune response, although further studies will be necessary to clarify the pathologic mechanisms responsible.
AB - Objective: To demonstrate that U-2 pilot occupational exposure to hypobaria leads to increased incidence of white matter hyperintensities (WMH) with a more uniform distribution throughout the brain irrespective of clinical neurologic decompression sickness history. Methods: We evaluated imaging findings in 102 U-2 pilots and 91 controls matched for age, health, and education levels. Three-dimensional, T2-weighted, high-resolution (1-mm isotropic) imaging data were collected using fluid-attenuated inversion recovery sequence on a 3-tesla MRI scanner. Whole-brain and regionalWMHvolume and number were compared between groups using a 2-tailed Wilcoxon rank sum test. Results: U-2 pilots demonstrated an increase in volume (394%; p 5 0.004) and number (295%; p, 0.001) ofWMH. Analysis of regional distribution demonstratedWMH more uniformly distributed throughout the brain in U-2 pilots compared with mainly frontal distribution in controls. Conclusion: Pilots with occupational exposure to hypobaria showed a significant increase inWMH lesion volume and number. Unlike the healthy controls with predominantly WMH in the frontal white matter, WMH in pilots were more uniformly distributed throughout the brain. This is consistent with our hypothesized pattern of damage produced by interaction between microemboli and cerebral tissue, leading to thrombosis, coagulation, inflammation, and/or activation of innate immune response, although further studies will be necessary to clarify the pathologic mechanisms responsible.
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U2 - 10.1212/WNL.0b013e3182a1ab12
DO - 10.1212/WNL.0b013e3182a1ab12
M3 - Article
VL - 81
SP - 729
EP - 735
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 8
ER -