Make the Dx: Solution to 'Deep dive'

By MDLinx staff
Published October 11, 2023

Key Takeaways

Can you make the diagnosis? Click here to review the case and check your answer below.

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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