open access

Vol 71, No 2 (2020)
Case report
Published online: 2020-06-27
Submitted: 2020-03-27
Accepted: 2020-04-20
Get Citation

Decompression illness type II with stroke: challenging situation in acute neurorehabilitation

Harleen Uppal, Uditha Jayatunga
DOI: 10.5603/IMH.2020.0019
·
Pubmed: 32604454
·
International Maritime Health 2020;71(2):105-108.

open access

Vol 71, No 2 (2020)
MARITIME MEDICINE Case report
Published online: 2020-06-27
Submitted: 2020-03-27
Accepted: 2020-04-20

Abstract

A professional 55-year-old female experienced diver, who surfaced after the second dive, had a lucid interval before dropping Glasgow Coma Scale (GCS) to 3/15. She was admitted to intensive care unit and commenced on hyperbaric oxygen therapy. Her initial computed tomography of the head was normal but her magnetic resonance imaging of the brain at 48 hours showed extensive bilateral cortical watershed territory infarcts. She developed acute respiratory distress syndrome which resolved within a few days. Her GCS gradually improved from 3/15 to 6/15, was repatriated to United Kingdom after about 2 weeks of the insult and admitted to a tertiary care hospital where she had myoclonic seizures and was started on anti-epileptics. Then she was transferred to the Rehabilitation Medicine Ward of Leicester General Hospital, with GCS 14/15 with poor sitting balance, for her management and rehabilitation. She had weakness of right upper and lower limbs, dysarthria, neuropathic bilateral shoulder pains, pressure ulcer of left heel, bladder and bowel incontinence and cognitive issues. She improved to have significant neurological recovery within next 3 months, became ambulant independently and bladder and bowel continent. Her Barthel index (from 4 to 17), Montreal Cognitive Assessment Test, Adembrook Cognitive Examination and Berg Balance scale (from 33/56 to 44/56) improved significantly. Early diagnosis, treatment and rehabilitation can have a significant impact on the recovery of decompression illness.

Abstract

A professional 55-year-old female experienced diver, who surfaced after the second dive, had a lucid interval before dropping Glasgow Coma Scale (GCS) to 3/15. She was admitted to intensive care unit and commenced on hyperbaric oxygen therapy. Her initial computed tomography of the head was normal but her magnetic resonance imaging of the brain at 48 hours showed extensive bilateral cortical watershed territory infarcts. She developed acute respiratory distress syndrome which resolved within a few days. Her GCS gradually improved from 3/15 to 6/15, was repatriated to United Kingdom after about 2 weeks of the insult and admitted to a tertiary care hospital where she had myoclonic seizures and was started on anti-epileptics. Then she was transferred to the Rehabilitation Medicine Ward of Leicester General Hospital, with GCS 14/15 with poor sitting balance, for her management and rehabilitation. She had weakness of right upper and lower limbs, dysarthria, neuropathic bilateral shoulder pains, pressure ulcer of left heel, bladder and bowel incontinence and cognitive issues. She improved to have significant neurological recovery within next 3 months, became ambulant independently and bladder and bowel continent. Her Barthel index (from 4 to 17), Montreal Cognitive Assessment Test, Adembrook Cognitive Examination and Berg Balance scale (from 33/56 to 44/56) improved significantly. Early diagnosis, treatment and rehabilitation can have a significant impact on the recovery of decompression illness.

Get Citation

Keywords

decompression sickness, scuba diving, the bends, hyperbaric oxygen therapy, hyperbaric chamber

About this article
Title

Decompression illness type II with stroke: challenging situation in acute neurorehabilitation

Journal

International Maritime Health

Issue

Vol 71, No 2 (2020)

Article type

Case report

Pages

105-108

Published online

2020-06-27

DOI

10.5603/IMH.2020.0019

Pubmed

32604454

Bibliographic record

International Maritime Health 2020;71(2):105-108.

Keywords

decompression sickness
scuba diving
the bends
hyperbaric oxygen therapy
hyperbaric chamber

Authors

Harleen Uppal
Uditha Jayatunga

References (13)
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