Diving after a stroke

[Adrian-]

I had a tiny acute infarct in the right thalamus on Sunday I have been discharged with the remainder of my treatment to be done as an out patient. For anyone that understands these things my discharge note reads: 'There is a small dot of T2 hyperintensity and mild defusion restriction within the right thalmus, which is suggestive of a tiny acute infarct'. Having recently certified I was looking forward to getting back in the water later this year and have been trying to find out whether a stroke is going to limit that.

From what I have read there isn't anything that it is going to outright arbitrarily stop me from diving and it's going to be down to individual medical advice. Is there anything in particular I need to ask my doctor in relation to diving or is it simply 'am I fit to dive'? Provided I am fit to dive I'll need a letter of some sort confirming this, is there anyone UK based who has experience of this is it something I'll get from my consultant/GP or do I need to make a private appointment with a doctor.

In terms of minimising future risk about the only thing I have found is that the Valsalva technique can cause inter cranial pressure to increase and be a risk factor, has anyone any experience of this and changed their method of equalising after a stroke? I was planning on doing an AOW course in October, does diving at depth increase any risk factors other than being a greater distance from the surface?

Over the next couple of weeks I'm going to be undertaking tests to hopefully determine what was the root cause, I have been warned that its not always possible to be absolute with this though. For reference I am 35 years old.

 

[krawlings]

I would STRONGLY suggest that you call DAN (1-800-446-2671 NON-EMERGENCIES 1-919-684-9111 EMERGENCY HOT LINE) You can ask them for information and you can all so find a Doctor in your area that is a dive savvy doctor . and then I would make an appointment to see him and be checked out and he can advise you best as YOUR Doctor Good Luck Your safety and HEALTH Is way more important than diving

 

[DocVikingo]

Hi Adrian,

Sorry to hear of that recent discovery.

Obviously you didn't just undergo an MRI of structures between the cerebral cortex and midbrain just because it was a slow day, and it would be useful to know what signs/symptoms you experienced to occasion such neuroimaging. Also, you mention scheduled outpatient treatment. What is this to involve? It would be nice to know the root cause, but as you say this may never be known.

In the meantime, you are correct that positive pressure equalization techniques such as the Valsalva can cause increased intracranial pressure, but diving depth per se does not.

Hopefully with more info this forum can be of some assistance.

Regards,

DocVikingo

 

[TSandM]

There are two major considerations: One is the issue that led to the stroke in the first place. You are extremely young for an ischemic stroke, and we look for things like drug use, uncontrolled hypertension, coagulation disorders, and cardiac anomalies, to name a few of the things that can produce unusual strokes. Another one that probably should be looked for, unless they KNOW what your problem is, is a PFO, or patent foremen ovale. This is associated with unusual stroke syndromes, and also with migraine headaches. Finding the reason for the stroke is important, because you do not want to have another one while you are in or under the water.

The second consideration is the neurologic damage that was done with the stroke. Diving requires good motor skills, good situational awareness, good communication skills, good emotional control, and good judgment. If any of those was compromised by the stroke damage, that could impact your fitness to dive. The neurologist following you would be in the best position to evaluate the degree of change from baseline.

 

[Adrian-]

Hi Adrian,

Sorry to hear of that recent discovery.

Obviously you didn't just undergo an MRI of structures between the cerebral cortex and midbrain just because it was a slow day, and it would be useful to know what signs/symptoms you experienced to occasion such neuroimaging. Also, you mention scheduled outpatient treatment. What is this to involve? It would be nice to know the root cause, but as you say this may never be known.

In the meantime, you are correct that positive pressure equalization techniques such as the Valsalva can cause increased intracranial pressure, but diving depth per se does not.

Hopefully with more info this forum can be of some assistance.

Regards,

DocVikingo

Cheers for taking the time to reply

While having a meal with friends I became numb in the left side of my face, tongue, lips and arm with my arm being the worse effected while I could move it it was complety numb. I was able to talk normally and called for an ambulance myself, the paramedic was on scene within 10 minutes and I was fine when he did the various hand squeeze, hold your arms out tests. I walked out of the restaurant and was even going to walk the 100 yards to the hospital rather than wait for an ambulance (the paramedic who was first on scene came by motorbike) until the paramedic found out that they didn't have a stroke unit there, so instead I was taken to another nearby hospital.

The symptoms reduced over the next four hours but still remained to a degree so a decision was made to admit me into a stroke ward for monitoring. I was discharged the following day with the symptoms by in large having passed and the MRI being completed, the MRI was also on my neck although they said that image quality was degraded by movement there was no significant stenosis and no irregularity to suggest arterial dissection.

Treatment at outpatients was probably poor phrasing it's more a case of further tests, what the consultant has requested is:
Carotid doppler
Echocardiogram
24 hour ECG
24 hour BP monitoring (this fluctuated quite significantly while in hospital)
LFT monitoring

They have put me on Asprin for two weeks to be replaced with Clopidogrel and Atorvastatin.

There are two major considerations: One is the issue that led to the stroke in the first place. You are extremely young for an ischemic stroke, and we look for things like drug use, uncontrolled hypertension, coagulation disorders, and cardiac anomalies, to name a few of the things that can produce unusual strokes. Another one that probably should be looked for, unless they KNOW what your problem is, is a PFO, or patent foremen ovale. This is associated with unusual stroke syndromes, and also with migraine headaches. Finding the reason for the stroke is important, because you do not want to have another one while you are in or under the water.

The second consideration is the neurologic damage that was done with the stroke. Diving requires good motor skills, good situational awareness, good communication skills, good emotional control, and good judgment. If any of those was compromised by the stroke damage, that could impact your fitness to dive. The neurologist following you would be in the best position to evaluate the degree of change from baseline.

Again a sincere thanks for replying, would the tests I have listed above pick up a PFO? I suffer from occasional migraines which are of a visual nature, no head pain just flashing lights in the periphery of my vision. I had a similar occurrence of the stroke symptoms three years ago, but less severe and much more short lived, which at the time was put down to a migraine.

In terms of the neurologic damage that was done I believe that I have come off very lightly at present (53 hours after the stroke) I have a slight numbness in my left cheek similar to a dental anesthetic wearing off and a pins and needles like sensation in my left thumb, the thumb doesn't feel like it has subsided much over the last twenty four hours but I do have a full range of movement with it. I Don't think my communication, emotional control or judgement have been effected, I was the calmest person in the group when this happened, dialled for my own ambulance (the emergency call handler sounded disbelieving when I said I think I am having a stroke until I described the symptoms) and made the decision to not take any of the friends with me to hospital as seeing them more worked up than I was I thought it would be more of a distraction rather than assistance. If there are any horrendous spelling mistakes or serious typos in this post that's quite normal for me me and should not be considered a symptom, I blame my iPad but in reality it's just normal for me.

This has been a bit of a wake up call for me, I was admitted to a stroke ward with around 30 beds on it, from a laymans point of view I was in significantly better shape then everyone else that I saw to the point where I felt like I was a burden on the doctors and nurses time. I'll be listening to medical advice and acting on it, I've even taken some time off work which is unusual for me.

One final question I was involved in a car crash 5 weeks ago, someone crashed into the back of me while stationary I felt no pain at the time subsequently had neck pain for a few days which then passed just leaving me with lower back and hip pain. At the hospital they asked me a lot about this and mention it in my discharge notes, if this is a possible cause would it show up on tests now or is it too late. As much as I don't want anything to be wrong with me I would much rather a cause be found so that I can do something about it.

 

[DocVikingo]

...would the tests I have listed above pick up a PFO?

Hi Adrian,

Yes, echocardiography, provided it is transesophageal (TEE) with saline bubble contrast, is likely to pick up a PFO of any significant size.

Carotid duplex ultrasound appears a not unreasonable procedure at this stage of investigation, although transcranial Doppler monitoring of the middle cerebral artery system generally is a more accurate screening technique for PFO.

24 hour ECG, 24 hour BP & LFT monitoring also are reasonable techniques at this stage, but would not be expected to provide meaningful findings as regards PFO.

As regards your history of "occasional migraines which are of a visual nature with no head pain just flashing lights in the periphery of vision", PFO is most commonly associated with migraine with aura (symptoms such as dizziness, ringing in the ears, seeing zigzag lines or flashing lights, and/or heightened sensitivity to light that proceed excruciating headache). What you describe may be occular/opththalmic migraines, which are visual disturbances of a migrainous type that occur without headache. The relationship between this condition and PFO has not yet been studied to the best of my admittedly limited knowledge.

Regards,

DocVikingo