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The explanation for this stumper is exquisitely biochemical, although not validated. It is thought that a short surface interval between dives is a key risk factor for this phenomenon.
Indeed, decompression sickness is the most serious complication of breath-hold diving, albeit rare with an incidence of <3/100,000, resulting from rapid ascent or no decompression stops.
During the breath-hold exercises, the patient accumulated nitrogen in the blood (ie, nitrogen oversaturation), which likely led to endothelial dysfunction that disrupted the blood-brain barrier.
Alternatively, the nitrogen bubbles cause arterial occlusion, venous infarction, and vascular stasis. Hyperbaric oxygen therapy is curative by reducing the size of inert nitrogen bubbles.
Thus, vasogenic edema, a form of decompression sickness, resulted from hyperpermeability of the blood-brain barrier.
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