Only 37 cases of stroke during or soon after long-haul flights have been 
published to our knowledge. In this retrospective observational study, we 
searched the Royal Melbourne Hospital prospective stroke database and all 
discharge summaries from 1 September 2003 to 30 September 2014 for 
flight-related strokes, defined as patients presenting with stroke within 14days 
of air travel. We hypothesised that a patent foramen ovale (PFO) is an 
important, but not the only mechanism, of flight-related stroke. We describe the 
patient, stroke, and flight characteristics. Over the study period, 131 million 
passengers arrived at Melbourne airport. Our centre admitted 5727 stroke 
patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke 
patients were younger (median age 65 versus 73, p<0.001), had similar stroke 
severity, and received intravenous thrombolysis more often than 
non-flight-related stroke patients. Seven patients had flight-related 
intracerebral haemorrhage. The aetiology of the ischaemic strokes was 
cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one 
with atrial septal defect, four with atrial fibrillation, one with endocarditis, 
and one with aortic arch atheroma. Paradoxical embolism was confirmed in six 
patients. Stroke related to air travel is a rare occurrence, less than one in a 
million. Although 20% of patients had a PFO, distribution of stroke aetiologies 
was diverse and was not limited to PFO and paradoxical embolism.