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      Magnetic Resonance Imaging in Breath-Hold Divers with Cerebral Decompression Sickness

      case-report

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          Abstract

          The mechanism of cerebral decompression sickness (DCS) is still unclear. We report 2 cases of breath-hold divers with cerebral DCS in whom magnetic resonance imaging (MRI) demonstrated distinctive characteristics. One case presented right hemiparesthesia, diplopia, and gait disturbance after breath-hold diving into the sea at a depth of 20 m. Brain MRI with fluid-attenuated inversion recovery (FLAIR) sequence revealed multiple hyperintense lesions in the right frontal lobe, bilateral thalamus, pons, and right cerebellar hemisphere. The second case presented visual and gait disturbance after repetitive breath-hold diving into the sea. FLAIR imaging showed hyperintense areas in the bilateral occipito-parietal lobes. In both cases, diffusion-weighted imaging and apparent diffusion coefficient mapping revealed hyperintense areas in the lesions identified by FLAIR. Moreover, follow-up MRI showed attenuation of the FLAIR signal abnormalities. These findings are suggestive of transient hyperpermeability in the microvasculature as a possible cause of cerebral DCS.

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          Most cited references18

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          Diffusion MRI: apparent diffusion coefficient (ADC) values in the normal brain and a classification of brain disorders based on ADC values.

          R Sener (2016)
          Diffusion-weighted imaging, dependent on motion of water molecules, provides information regarding tissue integrity. Apparent diffusion coefficient (ADC) values in the normal brain parenchyma, and those in a variety of lesions were studied by echo-planar diffusion MRI in 310 cases. Brain disorders were classified based on their ADC values, taking the ADC values of the normal brain white matter as the principal category. In the normal white matter ADC ranges were 0.60-1.05x10(-3)mm(2)/s, and the mean ADC value was 0.84+/-0.11x10(-3)mm(2)/s. It was possible to distribute brain disorders, as well as artefacts on diffusion MRI to five major categories: category 1, ADC similar to normal white matter; category 2, ADC lower than normal white matter; category 3, ADC higher than normal white matter; category 4, ADC similar to CSF; and category 5, markedly low or high ADC. Further studies can provide addition of different lesions as well as refinements of these categories.
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            White matter hyperintensities on MRI in high-altitude U-2 pilots

            To demonstrate that U-2 pilot occupational exposure to hypobaria leads to increased incidence of white matter hyperintensities (WMH) with a more uniform distribution throughout the brain irrespective of clinical neurologic decompression sickness history.
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              Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers.

              In divers, the significance of a patent foramen ovale and its potential relation to paradoxical gas emboli remain uncertain. To assess the prevalence of symptoms of decompression illness and ischemic brain lesions in divers with regard to the presence of a patent foramen ovale. Retrospective cohort study. University hospital and three diving clubs in Switzerland. 52 sport divers and 52 nondiving controls. Prevalence of self-reported decompression events, patent foramen ovale on contrast transesophageal echocardiography, and ischemic brain lesions on magnetic resonance imaging. The risk for decompression illness events was 4.5-fold greater in divers with patent foramen ovale than in divers without patent foramen ovale (risk ratio, 4.5 [95% CI, 1.2 to 18.0]; P = 0.03). Among divers, 1.23 +/- 2.0 and 0.64 +/- 1.22 ischemic brain lesions per person (mean +/- SD) were detected in those with and those without patent foramen ovale, respectively. Among controls, 0.22 +/- 0.44 and 0.12 +/- 0.63 lesion per person were detected (P < 0.001 for all groups). Regardless of whether a diver has a patent foramen ovale, diving is associated with ischemic brain lesions.
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                Author and article information

                Journal
                Case Rep Neurol
                Case Rep Neurol
                CRN
                Case Reports in Neurology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1662-680X
                Jan-Apr 2014
                24 January 2014
                24 January 2014
                : 6
                : 1
                : 23-27
                Affiliations
                [1] aDepartment of Medicine and Clinical Science, Fukuoka, Japan
                [2] bDepartment of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
                [3] cDepartment of Cerebrovascular Medicine, Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan
                Author notes
                *Ryu Matsuo, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan), E-Mail rymatsuo@ 123456intmed2.med.kyushu-u.ac.jp
                Article
                crn-0006-0023
                10.1159/000357169
                3934779
                24575029
                cebf0763-d20d-4374-92e8-7936b3f0a804
                Copyright © 2014 by S. Karger AG, Basel

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                History
                Page count
                Figures: 1, References: 14, Pages: 5
                Categories
                Published online: January, 2014

                Neurology
                blood-brain barrier,vasogenic edema,magnetic resonance imaging,decompression illness
                Neurology
                blood-brain barrier, vasogenic edema, magnetic resonance imaging, decompression illness

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