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VOLUME 25 , ISSUE 1 ( March, 2014 ) > List of Articles

CASE REPORT

Spinal Cord Injury in Decompression Sickness: A Case Report

M Henry Prakash, Ramaswamy Hariharan, Bobeena Chandy

Citation Information : Henry Prakash M, Hariharan R, Chandy B. Spinal Cord Injury in Decompression Sickness: A Case Report. Indian J Phy Med Rehab 2014; 25 (1):18-21.

DOI: 10.5005/ijopmr-25-1-18

Published Online: 00-03-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Study Design

Case report.

Objective

To describe an unusual case of deep diving followed by spinal cord injury due to decompression sickness (DCS).

Setting

Princess Royal Spinal Injuries Centre, Sheffield Teaching Hospitals NHS Foundation Trust, England.

Method

Description and observation of management and outcomes, of spinal decompression sickness (DCS).

Results

The patient's symptoms and signs developed after she surfaced after a deep sea diving event. She was managed and treated in a tertiary level care hospital. MRI performed within 24 hours, showed signs of increased signal intensity in the cervical and thoracolumbar regions. She was treated with hyperbaric oxygen which improved her pain symptoms but there was no immediate resolution in motor sensory deficits. Repeat MRI done after a week showed resolution if hyperintensity in the cervical region but not in the thoracolumbar region. Patient progressed to have significant neurological recovery in the next 6 months. She became ambulant with unilateral ankle foot orthotic and a pair of crutches, she continued to have bladder incontinence at 1 year follow-up interval.

Conclusion

Central nervous involvement is not uncommon in decompression sickness in divers. Early diagnosis and proper management can reduce acute symptoms and prevent further complications of permanent neurological disability. Primary prevention by education and adhering to standard diving guidelines is needed to reduce mortality and morbidity in decompression sickness.


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  1. D AAB, Davis JC. Bove and Davis’ Diving Medicine. Elsevier Health Sciences, 2004.
  2. May 12-16, 2013. Chicago, Illinois, USA. Aviat Space Environ Med 2013;84:275-439.
  3. Prognostic factors of spinal cord decompression sickness in recreational diving: retrospective and multicentric analysis of 279 cases. Neurocrit Care 2011;15:120-7.
  4. Hyperbaric oxygenation in fluid microembolism. Neurol Res 2007;29:156-61.
  5. Activation of complement and neutrophils increases vascular permeability during air embolism. Aviat Space Environ Med 1997;68:300-5.
  6. Activation of coagulation in decompression illness. Aviat Space Environ Med 1998;69:129-32.
  7. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:17-20.
  8. DAN; 2006.
  9. Paradoxical embolization and patent foramen ovale in scuba divers: screening possibilities. Vnitrní Lékarství 2007;53:143-6.
  10. [cited 2013 Jun 18]. Available from: http://jmvh.org/article/pathophysiology-treatment-andaeromedical-retrieval-of-scuba-related-dci/
  11. The indigenous fisherman divers of Thailand; in water recompression. Int Marit Heal 1999;50:39-48.
  12. A critical assessment of Trendelenburg's position in the acute phase after a diving accident. Schweiz Z Für Sportmed 1993;41:123-5.
  13. First aid normobaric oxygen for the treatment of recreational diving injuries. 2007 [cited 2013 Jun 20]; Available from: http://archive.rubicon-foundation.org/xmlui/handle/123456789/5514
  14. Aspirin in decompression sickness. Therapie 2008;63:419-23.
  15. Cerebral magnetic resonance imaging of compressed air divers in diving accidents. Undersea Hyperb Med J Undersea Hyperb Med Soc Inc 2009;36:33-41.
  16. What is Bends? 1991 [cited 2013 Jun 18]; Available from: http://archive.rubicon-foundation.org/xmlui/handle/123456789/7997.
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