[Central nervous system involvement in patients with decompression illness].
Dysbarism or decompression illness (DCI), a general term applied to all pathological changes secondary to altered environmental pressure, has two forms decompression sickness (DCS) and arterial gas embolism (AGE) after pulmonary barotrauma. Cerebral and spinal disorders have been symptomatically categorized as AGE and DCS, respectively. Magnetic resonance images (MRIs) of divers with DCI showed multiple cerebral infarction in the terminal and border zones of the brain arteries. In addition, there were no differences between MRI findings for compressed air and breath-hold divers. Although the pathogenesis of the brain is not well understood, we propose that arterialized bubbles passing through the lungs and heart involved the brain. From the mechanisms of bubble formation, however, this disorder has been classified as DCS. We propose that there is a difference between clinical and mechanical diagnoses in the criteria of brain DCI. In contrast to brain injury, the spinal cord is involved only in compressed air divers, and is caused by disturbed venous circulation due to bubbles in the epidural space. The best approach to prevent diving accidents is to make known the problems for professional and amateur divers.
Kohshi
Kiyotaka
K
Department of Neurosurgery, Division of Hyperbaric Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
Katoh
Takahiko
T
Abe
Haruhiko
H
Wong
Robert M
RM
D002490:Central Nervous System / Q000473:pathology*; D003665:Decompression Sickness / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D004242:Diving / Q000009:adverse effects*; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D008279:Magnetic Resonance Imaging; D016273:Occupational Exposure / Q000009:adverse effects