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Case Report

Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology

1
Department of Neurology, University Hospital Complex of Cartagena (Santa Lucia University Hospital—Santa María del Rosell University Hospital), 30202 Cartagena, Spain
2
Department of Cell Biology and Histology, Faculty of Medicine/Dentistry, Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, 30100 Murcia, Spain
3
Department of Radiology, University Hospital Complex of Cartagena (Santa Lucia University Hospital—Santa María del Rosell University Hospital), 30202 Cartagena, Spain
4
Department of Underwater and Hyperbaric Medicine, Spanish Navy Diving Center, La Algameca Naval Station, 30205 Cartagena, Spain
*
Author to whom correspondence should be addressed.
Academic Editor: Emilio Quaia
Tomography 2022, 8(3), 1172-1183; https://doi.org/10.3390/tomography8030096
Received: 21 February 2022 / Revised: 14 April 2022 / Accepted: 15 April 2022 / Published: 19 April 2022
Central nervous system involvement related to decompression sickness (DCS) is a very rare complication of breath-hold diving. So far, it has been postulated that repeated dives with short surface intervals represent a key factor in the development of breath-holding-related DCS. We report the case of a breath-hold diver who, after repeated immersion, developed DCS with brain involvement. After treatment in a hyperbaric chamber, there was a clinical improvement in the symptoms. Magnetic resonance imaging of the brain showed hyperintense lesions in long-time repetition sequences (FLAIR, T2WI) in the left frontal and right temporal lobes. Diffusion-weighted imaging (DWI) sequences and the apparent diffusion coefficient (ADC) map were characteristic of vasogenic edema, allowing us to exclude the ischemic nature of the process. These findings, together with the acute clinical presentation, the resolution of lesions in evolutionary radiological controls and the possible involvement of blood–brain barrier/endothelial dysfunction in DCS, could suggest a new form of posterior reversible encephalopathy syndrome (PRES)-like presentation of DCS. This would represent a novel mechanism to explain the pathophysiology of this entity. We conducted a literature review, analyzing the pathophysiological and neuroimaging characteristics of DCS in breath-hold diving based on a case of this rare disease. View Full-Text
Keywords: decompression sickness; breath-hold diving; magnetic resonance imaging; diffusion-weighted images; apparent diffusion coefficient maps; PRES decompression sickness; breath-hold diving; magnetic resonance imaging; diffusion-weighted images; apparent diffusion coefficient maps; PRES
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MDPI and ACS Style

Sánchez-Villalobos, J.M.; Fortuna-Alcaraz, M.L.; Serrano-Velasco, L.; Pujante-Escudero, Á.; Garnés-Sánchez, C.M.; Pérez-Garcilazo, J.E.; Olea-González, A.; Pérez-Vicente, J.A. Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology. Tomography 2022, 8, 1172-1183. https://doi.org/10.3390/tomography8030096

AMA Style

Sánchez-Villalobos JM, Fortuna-Alcaraz ML, Serrano-Velasco L, Pujante-Escudero Á, Garnés-Sánchez CM, Pérez-Garcilazo JE, Olea-González A, Pérez-Vicente JA. Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology. Tomography. 2022; 8(3):1172-1183. https://doi.org/10.3390/tomography8030096

Chicago/Turabian Style

Sánchez-Villalobos, José M., María L. Fortuna-Alcaraz, Laura Serrano-Velasco, Ángel Pujante-Escudero, Carmen M. Garnés-Sánchez, Jorge E. Pérez-Garcilazo, Agustín Olea-González, and José A. Pérez-Vicente. 2022. "Breath-Hold Diving-Related Decompression Sickness with Brain Involvement: From Neuroimaging to Pathophysiology" Tomography 8, no. 3: 1172-1183. https://doi.org/10.3390/tomography8030096

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