Diving and Subaquatic Medicine

The case of a 60-year-old male patient who was admitted to hospital because of a scuba diving accident is reported. The patient initially complained about dizziness and pain in the shoulders. The exact rate of ascent from diving was not known, however, the patient said that he had had a panic attack and went up very fast from a depth of at least 15 m. despite a rapid recompression the patient developed hypesthesia of the right upper limb 2 days later. To rule out a stroke magnetic resonance imaging (MrI) of the brain and the whole spinal column was performed.MrI examinations were carried out with a 1.5 Tesla system (siemens Magnetom espree). The imaging protocol included a diffusionweighted (dW) single-shot spin echo echoplanar sequence acquired from the anterior commissure-posterior commissure. For dW MrI, the diffusion gradients were successively and separately applied in three orthogonal directions for a total acquisition time of 97 s. Trace images were then generated and apparent diffusion coefficient (ADC) maps calculated with a dedicated software tool (syngo; siemens).These studies revealed signal alterations in the cervical spinal cord with an increased signal in diffusion and T2-weighted images at the level of the fourth and fifth cervical vertebral body, affecting both grey and white matter (Fig. 1). diffusion-weighted imaging at the same level detected some bright lesions (Fig. 2), which could be correlated with signal alterations in T2-weighted sequences and the ADC maps also revealed a high signal in these regions (Fig. 3). The MrI scans of the brain did not detect any abnormalities. Because of these finding the diagnosis of spinal decompression sickness was made.After treatment in the decompression chamber with hyperbaric oxygen for 5 days the pain in the shoulders and the dizziness disappeared, however, the hypesthesia remained. DiscussionWith an increase in diving to greater depths, decompressionassociated injury is becoming more frequent [1]. According to the accepted decompression protocols, after deep submersion the pressure must be reduced gradually to avoid serious possibly life-threatening complications.Insufficient washout of excess inert gas during rapid ascent may result in bubble formation due to the relatively low ambient pressure [2].In the case reported here the patient went up very fast from a depth of at least 15 m. Furthermore he stated that he had made repetitive dives within a few hours, which increases the risk of decompression sickness [3].Decompression sickness is classified into two groups: type I includes joint pain, skin marbling, small patchy

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“…Insufficient washout of excess inert gas during rapid ascent may result in bubble formation due to the relatively low ambient pressure [2].…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging of the Spine in a Patient with Decompression Sickness

Vollmann

Lamperti²,

Magyar

et al. 2011

Clin Neuroradiol

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“…There are some interesting and important cardiovascular effects on the human body when under the surface of water [1,2].…”

Section: Pathophysiologymentioning

confidence: 99%

Diving and cardiology

Kraus¹,

Wendling²

2012

Cardiovasc Med

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SummaryHigher pressure under water and loss of gravity have special physiological effects on the human body and also influence the cardiovascular system. Cardiovascular disease is in addition to other medical problems a risk for diving. A careful examination is necessary for safe diving. In a cardiovascular evaluation there are three main questions: is there an illness or pathology which may cause either sudden cardiac death, syncope or impaired physical mobility.

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“…Bei dieser Befundkonstellation tritt für den behandelnde Arzt das Problem auf, dass ein Taucher mit Innenohrdekompressionserkrankung so schnell als möglich in einer Druckkammer behandelt werden soll, diese Therapie aber aufgrund des während des "Abtauchens" in der Kammer notwendigen Valsalva-Manövers und der daraus resultierenden Druckerhöhung im Labyrinth bei Tauchern mit Innenohrbarotrauma nach bisheriger Lehrmeinung [5,7,27] kontraindiziert ist.…”

Section: The Treatment Of Cochleovestibular Incidents After Divingunclassified

“…eine Dekompressionserkrankung des Innenohrs (rechts) wahrscheinlich machenGrundsätzlich gilt es, dass im Zweifel eine hyperbare Sauerstofftherapie nach beidseitiger Parazentese durchgeführt werden sollte. Liegen bei regelrechtem Spiegelbefund weitere Symptome einer Dekompressionserkrankung vor, kann auf die Parazentese vor der hyperbaren Sauerstofftherapie verzichtet werden Eine hyperbare Sauerstofftherapie muss so schnell wie möglich nach einem Tauchunfall eingesetzt werden, da ein verzöger-ter Therapiebeginn zu signifikant schlechteren Ergebnissen führt[4,5,7,16]. Aus diesem Grund darf der behandelnde Arzt keine Zeit für eine aufwendige Differenzialdiagnostik verschenken.…”

unclassified