title: Delayed blood-brain barrier disruption after shallow-water diving demonstrated by magnetic resonance imaging.
abstract: A 22-year-old diver presented to our emergency room complaining of headaches and left side numbness three days after diving to a depth of 6 metres for 25 minutes. On examination, he had left-sided hypaesthesia, and a post-contrast FLAIR brain MRI sequence revealed signiﬁcant diffuse meningeal enhancement, indicating blood-brain-barrier (BBB) disruption. The patient was treated with hyperbaric oxygen; the initial four sessions resulted in only partial symptom improvement correlating with partial improvement in the MRI ﬁndings. Ten additional hyperbaric treatments resulted in complete resolution of the symptoms and normalization of MRI ﬁndings. The main aim of this case report is to present a probable, atypical, delayed-onset case of shallow-water decompression sickness culminating in signiﬁcant BBB damage, which was demonstrated by special MRI techniques.
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Centre Zeriﬁn 7030, Israel, Phone: +972-(0)544707381, E-mail: Amir.had@gmail.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Hadanny
authors.affiliation: Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Imaging Division, Assaf Harofeh Medical Centre, Zeriﬁn.
authors.forename: Sigal
authors.initials: S
authors.lastname: Tal
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Resarch, Assaf Harofeh Medical Centre, Zeriﬁn, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gregori
authors.initials: G
authors.lastname: Fishlev
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Resarch, Assaf Harofeh Medical Centre, Zeriﬁn, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Bechor
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Resarch, Assaf Harofeh Medical Centre, Zeriﬁn, Israel, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Imaging Division, Assaf Harofeh Medical Centre, Zeriﬁn , Research and Development Unit, Assaf Harofeh Medical Centre, Zeriﬁn, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv.
authors.forename: Shai
authors.initials: S
authors.lastname: Efrati
mesh_terms: D001812:Blood-Brain Barrier; D003665:Decompression Sickness / Q000150:complications* / Q000628:therapy; D004242:Diving / Q000009:adverse effects*; D006261:Headache / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D006987:Hypesthesia / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges; D055815:Young Adult
keywords: Decompression sickness; brain; case report; hyperbaric oxygen therapy; persistent foramen ovale; radiological imaging