Diving with possible elevated intracranial pressure

[Rjscheuerle]

As an infant I was diagnosed with scaphocephaly. At 9 months old, I had a complete cranial reconstruction by Dr. Billmire at Cincinnati Children's Hospital. Since then, I have had intermittent intracranial pressure spikes. After moving to Austin, Texas at 4-5 years old I was having visual disturbances and was suffering from frequent, almost constant migraines. At the time I was only monitored by an ophthalmologist who saw signs of papilledema on my optic disc. Austin at the time didn't have a neurosurgeon and my condition and treatment isn't exactly common. My current neurosurgeon in Austin, Dr. Tim George, believes that I probably should've had another reconstruction to give my brain more space. Strangely, most of my ICP and papilledema symptoms subsided as I grew older. There has been times where my ICP has been suspected to be elevated. Several years ago while sick with mono, my optic nerve was lacking venus pulsations and I was very tired and getting more migraines. It was hard however to determine what was mono and was possible high ICP. Now, I only suffer from occasional migraines. CT scans reveal however that space is very, very tight.

I have always been a marine enthusiast. Over the years I have kept everything from sharks to coral in my many fish tanks. There is nothing I want more than to see this wildlife in its natural habitat. This summer I would like to do a study abroad program in Thailand. I have never dived before. My mom is terrified of it for me. Are her concerns justified? Would it be safe for me to participate in a program like this? Would it be safe for me to dive at all? I feel like Boyle's law shouldn't apply to my head given it doesn't contain gas. If anything I feel like diving should lower my intracranial pressure due to the anti-inflammatory effects of hyperoxia. In addition, isn't ICP related to the pressure differential not the absolute pressure? Pressure on the outside and pressure on the inside of my head should increase at the same rate given I follow standard dive protocol.

http://www.projects-abroad.org/volun...arine-project/

Thanks a lot!
Richard Scheuerle

 

[Duke Dive Medicine]

Hi Richard,

You're right on about Boyle's Law. The anti-inflammatory effects of hyperoxia do not begin to appear until the inspired pO2 reaches about 0.6 ATA, which would correspond to just over 60 feet of sea water. Even at that point the effect is relatively small compared to the effects we're able to achieve with our patients in the hyperbaric chamber.

One possible concern for diving with your condition would be CO2 retention. As you probably know, CO2 is a vasodilator, and increased levels of CO2 can result in an elevation in ICP in some individuals. Another concern would be that symptoms of elevated ICP can mimic decompression illness.

My suggestion would be to go see a board-certified diving physician, who will be able to look at your medical records and evaluate you in person. If you'd like a referral, feel free to send me a private message.

Best regards,
DDM