直升机飞行员脑白质高信号一例并文献复习

A case of helicopter pilot with white matter hyperintensities and literature review

目的总结直升机飞行员脑白质高信号（whitematterhyperintensities，WMHs）的影像特征、诊疗过程及航空医学鉴定。方法回顾性分析1例以“带状疱疹”来空军航空医学研究所载人离心机医学训练基地就诊、经MRI发现WMHs病例资料的直升机飞行员，并复习相关文献。分析WMHs的影像特征、发病机制、诊疗及航空医学鉴定。结果患者住院期间，因主诉间断性头晕2年，偶有心情烦躁、入睡困难等不适，行头颅MRI检查，结果显示双侧额顶叶皮层下白质可见多发斑点状稍长T1、T2异常信号，液体衰减反转恢复脉冲序列像呈高信号，提示双侧额顶叶皮层下脑白质多发性缺血灶可能。结合其他检查排除心血管疾病、前庭性眩晕、颈性眩晕等疾病，予以改善睡眠、高压氧等对症治疗，2周后头晕、失眠症状明显缓解，经鉴定飞行合格，予以出院。结论WMHs与首发或复发性缺血性卒中、脑出血、痴呆、甚至死亡的风险性增加密切相关。飞行员wMHs的数量与体积远高于普通人，可能与低压缺氧、高空减压、加速度相关。鉴于直升机飞行员工作环境的特殊性，临床航空医生应提高对WMHs的认识，为其预防、治疗和航空医学鉴定提供依据。

Objective To summarize the image characteristics of white matter hyperintensities （WMHs） and aeromedical assessment by reviewing the process of diagnosis and treatment of a helicopter pilot with WMHs. Methods A case of helicopter pilot, who was diagnosed as ＂herpes zoster＂ in Human Centrifuge Medical Training Base, Institute of Aviation Medicine, Air Force, but finally WMHs determined by MRI exam, was retrospectively analyzed and literature was reviewed. The image characteristics of WMHs, pathogenesis, diagnosis and treatment, and aeromedical assessment for the pilots were analyzed. Results The pilot received MRI exam due to his complaint on 2-year intermittent dizziness, oceasional agitated and sleeping difficulty. The head MRI showed that the multiple spots could be seen in the bilateral and subcortical white matter of the frontal, parietal lobe with slightly longer T1, T2 and hyperintense signals were observed on the fluid attenuated inversion recovery image. Those suggested multiple focal subcortical ischemia in bilateral frontal and parietal lobe. Referring to other examinations, we eliminated the possibilities of cardiovascular diseases, vestibule vertigo, cervical vertigo, and other diseases. Such symptomatic treatments as Lorazepam, hyperbaric oxygen, and other symptomatic treatments were prescribed to improve sleep and relief symptoms. The dizziness and insomnia were significantly eased after 2 weeks. The pilot was qualified and discharged from hospital. Conclusions WMHs have high risks on first-episode or recurrent ischemic stroke, cerebral hemorrhage, dementia, and even death. The WMHs lesion in pilots show much bigger volume and number than normal population and those may correlate to hypobaric exposure, hypoxia, altitude decompression and acceleration. More attention should be paid to the helicopter pilots working in special environment by knowing the clinical determination of WMHs and accumulating the experiences on prevention, diagnosis and treatment, and aeromedical assessment.