title: Decompression sickness in Miskito Indian lobster divers: review of 229 cases.
abstract: BACKGROUND
  The Miskito Indian lobster divers of Central America employ very provocative diving profiles and experience severe neurological decompression sickness (DCS) and/or arterial gas embolism (AGE). Scientific data are scarce regarding the clinical patterns of injury, response to treatment, and functional outcomes for such cases.
  
  
  METHODS
  A retrospective review of 229 cases of DCS and/or AGE was conducted at 2 hyperbaric units in Central America.
  
  
  RESULTS
  The following deficits were recorded on presentation: any neurological deficit: 94%; motor: 79%; sensory: 60%; urinary: 48%; reflex: 45%; and loss of consciousness: 20%. The patterns of weakness (n = 182) were as follows: paraparesis: 27%; paraplegia: 26%; lower extremity monoparesis: 14%; lower extremity monoplegia: 6%; quadriparesis: 4%; hemiparesis: 4%; hemiplegia: 3%; and quadriplegia: 2%. Treatment was delayed by a mean and median of 5 and 2 d, respectively. The majority received hyperbaric oxygen and systemic steroids. Motor function on discharge (n = 182) was as follows: normal: 30%; paraparesis: 15%; lower extremity monoparesis: 15%; paraplegia: 3%; quadriparesis: 2%; hemiparesis: 2%; and missing data/other: 33%. Gait on discharge (n = 182) was as follows: normal: 19%; abnormal: 19%; required one crutch: 10%; required two crutches: 16%; not ambulatory: 5%; and missing data: 31%.
  
  
  CONCLUSIONS
  The majority of severe injuries could be localized to the thoracolumbar spinal cord. One-fifth had bilateral cerebral dysfunction manifested by loss of consciousness. Despite long delays to treatment, divers responded to hyperbaric oxygen. At the time of discharge, almost a third had complete recovery of strength and the majority were ambulatory.
authors.affiliation: Department of Neurology, Louisiana State University, New Orleans, LA, USA. dbarratt@bellsouth.net
authors.forename: Diana M
authors.initials: DM
authors.lastname: Barratt
authors.forename: Keith
authors.initials: K
authors.lastname: Van Meter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002489:Central America / Q000453:epidemiology; D003665:Decompression Sickness / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D004242:Diving / Q000009:adverse effects*; D005398:Fisheries; D006801:Humans; D006931:Hyperbaric Oxygenation; D007197:Indians, Central American; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies