[Acute myelopathy in a diver caused by decompression sickness. A case description and a survey of the literature].
BACKGROUND
Decompression sickness (DS) is caused when bubbles of an inert gas usually nitrogen, since oxygen is metabolised in the tissues are released into the bloodstream and tissues during fast ascents once the atmospheric pressure is lowered near the surface. Neurological complications are its most serious form of expression and include vertigo, headache, stroke and acute myelopathy, among others. DS that affects the spinal cord is infrequent.


METHODS
A male, 42 years old, who presented progressive tetraparesis 15 minutes after returning to the surface following several immersions up to 40 metres deep in the same day. Neurological exploration revealed tetraparesis that was predominantly distal and in the lower limbs, a posterior cord syndrome, urinary incontinence and neurogenic pain. Total column magnetic resonance imaging showed areas of diffused hypersignal in the T2 sequence in the thoracic and cervical (C2 to C6) regions, predominating in the posterior cords. The echocardiogram, transcranial Doppler and spirometric studies ruled out an arterial gas embolism following pulmonary barotrauma.


CONCLUSIONS
Spinal DS can give rise to a serious myelopathy, which affects the pyramidal pathway, posterior cords and sphincteral control, and which generally appears after sudden ascents from the deep dives.
Carod-Artal
F J
FJ
Servicio de Neurología, Hospital Sarah, Brasilia DF, Brasil. javier@bsb.sarah.br
Vilela-Nunes
S
S
Fernandes-da Silva
T V
TV
D000328:Adult; D001469:Barotrauma / Q000473:pathology; D003665:Decompression Sickness / Q000150:complications* / Q000473:pathology*; D004242:Diving / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology*