Chiari I malformation with symptoms and no repair yet- can I dive?

[Valerie Sutherland]

I’ve been having vertigo and tinnitus and low heart rate to 42 for 6 months. MRI shows chiari I malformation with peg like cerebellar tonsils 8 mm below foramen magnum. I have 5 day live aboard trip next week with dives to 100 feet including 15 dives total with cave and night dives. Do I go dive or snorkel?

 

[rsingler]

Snorkel.

Dive Doc

 

[Valerie Sutherland]

Snorkel.

Dive Doc

Thank you

 

[rsingler]

Knowing zero about your actual condition, it's not the Chiari I. It's the vertigo and bradycardia.
It is unbelievable what even a brief bout of vertigo will do to your situational awareness at depth. Add in the potential effects of pressure on your venous system (reflex bradycardia) on top of your already low heart rate, and a brief moment of altered consciousness (which at the surface is nothing) is now a setup for loss of regulator and drowning. Good luck with your training. I'll bet you'll be diving regularly soon enough. Maybe not just yet.
There is not a lot about a Chiari I malformation per se which is at risk during a dive. Diving will not increase your intracranial volume except for compression of venous reservoirs at depth with modest shunting of blood volume into the central circulation, which does include the cerebral vessels. If your margin is narrow enough, I guess it is possible to become symptomatic from diving alone, but I do not think this very likely.

 

[Valerie Sutherland]

Thanks for additional info. Not sure what causes the vertigo. It seems to be related to intense physical activity at times, but I wear a heart rate strap and my heart rate seems to be responding normally to exercise. Do dive buddies mitigate risk sufficiently if the concern is the vertigo and not brainstorm herniation. I am internal medicine physician

 

[Valerie Sutherland]

When would you be concerned about chiari malformation and diving, if ever? Only after an incident?

 

[rsingler]

Please see my edited post above. Even a physician dive buddy would not be a reliable rescue resource at depth, absent dive training as a professional, with Rescue Diver being just the first step. And with a buddy having that training plus being a physician, I think you'd be only marginally better off.
I would recommend stepping back until the symptomatic part is resolved.

@Duke Dive Medicine

 

[Compressor]

Hi Valerie: Welcome to Scubaboard. Are you going to get your Chiari taken care of surgically? How symptomatic are you? When you turn your head back, do you get lightheaded?

I agree with @rsignler.

 

[Duke Dive Medicine]

I agree with @rsingler as well. Valerie, another consideration is that ICP increases with increased ambient pressure, and cerebral perfusion increases with immersion. I would recommend you refrain from diving until this is sorted out. Where in Washington are you? There's a topnotch diving physician in Seattle I can refer you to; it would be helpful to have him on your care team.

Best regards,
DDM

 

[Valerie Sutherland]

I agree with @rsingler as well. Valerie, another consideration is that ICP increases with increased ambient pressure, and cerebral perfusion increases with immersion. I would recommend you refrain from diving until this is sorted out. Where in Washington are you? There's a topnotch diving physician in Seattle I can refer you to; it would be helpful to have him on your care team.

Best regards,
DDM

Yes,(

Hi Valerie: Welcome to Scubaboard. Are you going to get your Chiari taken care of surgically? How symptomatic are you? When you turn your head back, do you get lightheaded?

I agree with @rsignler.

Hi Valerie: Welcome to Scubaboard. Are you going to get your Chiari taken care of surgically? How symptomatic are you? When you turn your head back, do you get lightheaded?

I agree with @rsignler.

Yes, I do get lightheaded when I turn my head. For several months now, whenever I put my 3 kids in the car and get in the driver seat, and then one or two of them calls out for me to pick something up they dropped on the floor they can't reach since they are in their car seats, I say I can't turn my head around and so I get out and go around or have one of the other kids get it.
I am a competitive body builder and after weight lifting, I feel very lightheaded and have pulled over a few times on the drive home fro the gym. I also sometimes have to grab onto my husband when I stand up. I was very lightheaded at work, did an ECG on myself, and it showed sinus bradycardia to 42. I am very fit, but I have been very fit my whole life and I have always been I resting HR contests with my husband who is triathlete and he has typically won but now my Garmin watch says my low HR is 42.
The local neurosurgeon looked at my MRI without the spine MRI or taking a history or doing physical and emailed my I could dive. I am waiting for appointment at U Washington but my MRI was Monday and my plane leaves Saturday. I don't know if they will recommend surgery. For now. I am just wondering if I should scuba dive. Thank you.