Intracerebral hemorrhage

[Duke Dive Medicine]

Mike, interesting thought, I'd wondered about that myself. I asked Dr. Friedman (in so many words) if there was some sort of threshold beyond which a subclinical bleed would become suddenly symptomatic and he thought that was an unlikely scenario. I agree, given the time between the dives and the sudden onset of symptoms, his ICH is probably not diving-related. I'd never say never though, because surely enough there'd be a case report to prove me wrong

Best regards,
DDM

 

[doctormike]

I'd never say never though, because surely enough there'd be a case report to prove me wrong

DDMs post is the most important insight that any of you will ever read. It applies equally well to all social media arguments. You can google up an example of absolutely anything.

 

[SJT1961]

I am a neurosurgeon. Reading your account of events, I agree it is unlikely (though not entirely impossible) given the interval between diving and onset of symptoms that this is related to diving. You should have MRA and/or conventional cerebral angiography to try to elucidate the cause of the bleed and rule out aneurysm or vascular malformations. Glad you are doing OK.

 

[Duke Dive Medicine]

I am a neurosurgeon. Reading your account of events, I agree it is unlikely (though not entirely impossible) given the interval between diving and onset of symptoms that this is related to diving. You should have MRA and/or conventional cerebral angiography to try to elucidate the cause of the bleed and rule out aneurysm or vascular malformations. Glad you are doing OK.

It looks like he had a head CT with contrast and they couldn't isolate a source. Out of curiosity, how common is it to have an ICH without an identified source?

Best regards,
DDM

 

[SJT1961]

ICH without identifiable source is fairly common. Could be due to vein rupture, hypertension, bland infarction with subsequent bleed, amyloid, bleed into tumor and other causes. A simple contrasted head CT is not sensitive enough to rule out all causes. Venous angiomas, cavernous angiomas, small aneurysms, AVMs, vasculitis would usually require more advanced imaging, specifically directed at vascular anatomy. CT angio, MR angio (MRA), or conventional catheter angio. The idea here is to rule out treatable causes to avoid additional bleeds if possible. This is a general answer. Without seeing the location and appearance on imaging thus far, difficult to comment more precisely. Hope this answers your question.

 

[Duke Dive Medicine]

It does, thank you, great post!

Best regards,
DDM

 

[Steve_C]

General question. I see lots of recommendations of dive or no dive. A gentle reef dive to say a max of 30 ft can be quite pleasant and low stress. Are there ever recommendations that say ok to keep diving but keep it shallow and low effort? Question coming from a 72 year old diver who has not been told this yet but is assuming nature will take its toll.

 

[Duke Dive Medicine]

Steve, do you have specific health problems that you're concerned about, or are you looking for a general recommendation based on age? You're local, it would be pretty easy for you to schedule an appointment with us for a diving physical if you have concerns.

Best regards,
DDM

 

[Steve_C]

Steve, do you have specific health problems that you're concerned about, or are you looking for a general recommendation based on age? You're local, it would be pretty easy for you to schedule an appointment with us for a diving physical if you have concerns.

Best regards,
DDM

No health issues at this time and I get an annual physical. But I have noted that I don't recall seeing any of the easy diving recommendations on SB. I realize of course that any actual recommendation would depend on the issues involved and be diver specific. I have noticed that I am a bit more susceptible to sea sickness than I used to be and balance while good is not that of a 20 year old. Probably related. So I am keeping most of my diving 85 ft and above and shorter boat rides (unless I can get to Frying Pan or one of the nearer ledges.) But frying pan is shallow. I also now avoid high effort dives like strong currents, physical effort at depth, etc. Just being conservative.

 

[Malcolm White]

Thanks everyone for the advise. I am due another CT scan in 2 weeks and a consultant visit in 3 months. I will then enquire further of my consultant about a probable cause and likely reoccurance.

Note: I should add that I have an annual Class 2 Aeromedical and all my ECGs (both at the aeromedical and several last week in hospital) all came out completely clear. During the next few weeks, I also have appointments for a heart ultrasound and a Holter ECG.