Abstract
IntroductionTo the best of our knowledge, the association between air travel and intra-tumoral hemorrhage in pediatric populations has never been described previously.Case presentationWe report the case of a two-and-a-half-year-old Caucasian, Iranian boy with a hemorrhaging brain tumor. He had a posterior fossa midline mass and severe hydrocephalus. He had been shunted for hydrocephalus four weeks earlier and was subsequently referred to our center for further treatment. The hemorrhage occurred in an infra-tentorial ependymoma, precipitated by an approximately 700-mile air journey at a maximum altitude of 25,000 feet.ConclusionsA pre-existing intra-cranial mass lesion diminishes the ability of the brain to accommodate the mild environmental disturbances caused by hypercarbia, increased venous pressure and reduced cerebral blood flow during long air journeys. This is supported by a literature review, based on our current knowledge of physiological changes during air travel.
Highlights
To the best of our knowledge, the association between air travel and intra-tumoral hemorrhage in pediatric populations has never been described previously.Case presentation: We report the case of a two-and-a-half-year-old Caucasian, Iranian boy with a hemorrhaging brain tumor
A pre-existing intra-cranial mass lesion diminishes the ability of the brain to accommodate the mild environmental disturbances caused by hypercarbia, increased venous pressure and reduced cerebral blood flow during long air journeys. This is supported by a literature review, based on our current knowledge of physiological changes during air travel
The tissue type of the tumor itself is clearly related to its propensity to bleed, as metastatic lesions are known to carry a high risk of hemorrhage
Summary
This case together with previously described cases suggest that it is reasonable to caution patients with a known intra-cranial mass lesion about the possible risks of commercial flight. Prophylactic medications such as steroid agents, acetazolamide, and supplementary O2 may be considered for these patients during air travel. In spite of all the suggested mechanisms, we believe that in order to offer thorough guidelines for patient care during flight, further studies need to be carried out with respect to the effects of air travel on health. Authors' contributions AM, NB and FN managed our patient and collected and interpreted our patient data regarding the disease and the possible mechanism of hemorrhage during flight.
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