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Economy class stroke syndrome

This is a relatively new clinical entity regarding people traveling many hours in an airplane. Deep vein thrombosis may happen and pulmonary embolism is following which in some cases may be lethal. In addition, or regardless of the presence of pulmonary embolism, in very rare cases, the traveller may suffer a stroke as a consequence of passing of clots through a small hole between the two atria of the heart. This hole is called Patent Foramen ovale (PFO) and this mechanism is known as paradoxical embolism. PFO is present in up to 25% of the population -- but very few isolated cases are reported in the literature on stroke during flight due to PFO.

We recently diagnosed such a case at Cardiac Care Centre. A 67-year old male traveling from Scotland to Pafos, Cyprus suffered five repeated strokes, the first one while on board the plane, and the rest over the course of a few days. Medical professionals must be aware of this clinical syndrome in order to request the appropriate examination for early diagnosis. The diagnosis needs a high level of suspicion and is done by Transoesophageal echocardiography and infusion of contrast material. We believe this is the first case reported in Cyprus.

In the video a doctor can see many bubbles crossing PFO from Right atrium to the Left atrium. This was the route the thrombi followed from lower limbs and moved to different parts of the brain.

These serious conditions are an important reason why travelers must move and walk periodically during flights, especially those sitting in economy class with limited space. Prophylaxis via repeated walking in the corridors is essential for safe travel.

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