Vol 71, No 2 (2020)
Case report
Published online: 2020-06-27

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

Harleen Uppal1, Uditha Jayatunga1
Pubmed: 32604454
IMH 2020;71(2):105-108.


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.

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  1. Gill AL, Bell CNA. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM. 2004; 97(7): 385–395.
  2. Vann R, Butler F, Mitchell S, et al. Decompression illness. Lancet. 2011; 377(9760): 153–164.
  3. Klapa S, Meyne J, Kähler W, et al. Decompression illness with hypovolemic shock and neurological failure symptoms after two risky dives: a case report. Physiol Rep. 2017; 5(6): 1–5.
  4. Vann R. Inert gas exchange and bubbles. Bove and Davis' Diving Medicine. 4th edn. Philadelphia, PA: Saunders. 2004: 53–76.
  5. Vann RD, Gerth WA, Denoble PJ, et al. Experimental trials to assess the risks of decompression sickness in flying after diving. Undersea Hyperb Med. 2004; 31: 431–444.
  6. Moon RE. Treatment of decompression. In: Diving Medicine 4th ed. Bove AA, Davis JC, eds. Philadelphia: Saunders. 2004: 195–223.
  7. Prakash MH, Hariharan R, Chandy B. Spinal cord injury in decompression sickness: a case report. Indian Journal of Physical Medicine and Rehabilitation. 2014; 25(1): 18–21.
  8. Smart D, Mitchell S, Wilmshurst P, et al. Joint position statement on persistent foramen ovale (PFO) and diving. South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Sports Diving Medical Committee (UKSDMC). Diving Hyperb Med. 2015 ; 45(2): 129–131.
  9. Jüttner B, Wölfel C, Liedtke H, et al. German Society for Diving and Hyperbaric Medicine, Swiss Underwater and Hyperbaric Medical, German Interdisciplinary Association for Intensive Care and Emergency Medicine, Naval Medical Institute, Sports Divers Association, Social Accident Insurance Institution for the Building Trade, Association of Hyperbaric Treatment Centers, Society of Occupational and Environmental Medicine. [Diagnosis and treatment of diving accidents. New German guidelines for diving accidents 2014-2017]. Anaesthesist. 2015; 64(6): 463–468.
  10. DeGorordo A, Vallejo-Manzur F, Chanin K, et al. Diving emergencies. Resuscitation. 2003; 59(2): 171–180.
  11. Oode Y, Yanagawa Y, Omori K, et al. Analysis of patients with decompression illness transported via physician-staffed emergency helicopters. J Emerg Trauma Shock. 2015; 8(1): 26–29.
  12. MacDonald RD, O'Donnell C, Allan GM, et al. Interfacility transport of patients with decompression illness: literature review and consensus statement. Prehosp Emerg Care. 2006; 10(4): 482–487.
  13. Zamboni WA, Roth AC, Russell RC, et al. Morphologic analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr Surg. 1993; 91(6): 1110–1123.