title: Risk of Neurological Insult in Competitive Deep Breath-Hold Diving.
abstract: BACKGROUND
  It has been widely believed that tissue nitrogen uptake from the lungs during breath-hold diving would be insufficient to cause decompression stress in humans. With competitive free diving, however, diving depths have been ever increasing over the past decades.
  
  
  METHODS
  A case is presented of a competitive free-diving athlete who suffered stroke-like symptoms after surfacing from his last dive of a series of 3 deep breath-hold dives. A literature and Web search was performed to screen for similar cases of subjects with serious neurological symptoms after deep breath-hold dives.
  
  
  METHODS
  A previously healthy 31-y-old athlete experienced right-sided motor weakness and difficulty speaking immediately after surfacing from a breathhold dive to a depth of 100 m. He had performed 2 preceding breath-hold dives to that depth with surface intervals of only 15 min. The presentation of symptoms and neuroimaging findings supported a clinical diagnosis of stroke. Three more cases of neurological insults were retrieved by literature and Web search; in all cases the athletes presented with stroke-like symptoms after single breath-hold dives of depths exceeding 100 m. Two of these cases only had a short delay to recompression treatment and completely recovered from the insult.
  
  
  CONCLUSIONS
  This report highlights the possibility of neurological insult, eg, stroke, due to cerebral arterial gas embolism as a consequence of decompression stress after deep breath-hold dives. Thus, stroke as a clinical presentation of cerebral arterial gas embolism should be considered another risk of extreme breath-hold diving.
authors.forename: Kay
authors.initials: K
authors.lastname: Tetzlaff
authors.forename: Holger
authors.initials: H
authors.lastname: Schöppenthau
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Schipke
mesh_terms: D000328:Adult; D062485:Breath Holding; D003163:Competitive Behavior / Q000502:physiology*; D003665:Decompression Sickness / Q000150:complications / Q000209:etiology*; D004242:Diving / Q000009:adverse effects* / Q000502:physiology; D004618:Embolism, Air / Q000150:complications / Q000209:etiology*; D006801:Humans; D008297:Male; D020521:Stroke / Q000209:etiology*; D013997:Time Factors
keywords: IPAVA; apnea; decompression sickness; gas embolism; hypoxia; stroke