A certified diver had a stroke 3 months ago. He was diagnosed as having a mild sroke, not TIA, and his sysmptoms lasted about 5 hours. His neurologist states that he has no residual effects from the stroke and has normal motor, speach, and brain funtion, no paralysis, no memory loss or memory problems. His neurologis, not a dive medicine doctor, states that he could return to diving without problem. He is on aspirin therapy. I know that strokle is a contradiction to diving. The diver wants to attend continuing education in diving. Your comments are welcome.
Mild Stroke Victims
- Thread starter rogersce
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Both cerebrovascular accident (stroke or CVA) and TIA (Transient Ischemic Attack)are thought to disqualify diving. The reason for this is that even though apparent complete function has been restored, there is the likelihood of loss of neural reserve with possible local decrease in blood flow that might make decompression sickness more likely. (Not proven and debatable)
There is also the consideration that the CVA might have been due to the passage of venous emboli across a septal defect, a situation that could be replicated by the venous bubbling that occurs in most divers on ascent.
Whether or not aspirin is beneficial to diving is debatable - some thinking that it reduces the risk of the effects of bubbling on the blood; others believing that the anti-coagulant effect is detrimental due to the possibility of hemorrhage from ear, sinus and pulmonary barotrauma. It is known that decompression per se reduces platelet count and may even cause thrombocytopenia, which would aggravate any bleeding diathesis. (This is believed to result from platelet consumption by adherence to bubbles).
All in all, one always hesitates to contradict the advice of the diver's doctor. When that advice is predicated by knowledge of the possible untoward effects of diving it certainly becomes more meaningful in making a decision whether or not to dive.
There is also the consideration that the CVA might have been due to the passage of venous emboli across a septal defect, a situation that could be replicated by the venous bubbling that occurs in most divers on ascent.
Whether or not aspirin is beneficial to diving is debatable - some thinking that it reduces the risk of the effects of bubbling on the blood; others believing that the anti-coagulant effect is detrimental due to the possibility of hemorrhage from ear, sinus and pulmonary barotrauma. It is known that decompression per se reduces platelet count and may even cause thrombocytopenia, which would aggravate any bleeding diathesis. (This is believed to result from platelet consumption by adherence to bubbles).
All in all, one always hesitates to contradict the advice of the diver's doctor. When that advice is predicated by knowledge of the possible untoward effects of diving it certainly becomes more meaningful in making a decision whether or not to dive.
Dr Deco
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Dear rogersce:
[sp]"There is also the consideration that the CVA might have been due to the passage of venous emboli across a septal defect, a situation that could be replicated by the venous bubbling that occurs in most divers on ascent."
The aspect of passage of blood clots through a patent foramen ovale (PFO) is very well documented in the population as a whole. This is described as the cause of paradoxical stoke in some individuals. (It is also called vein-to-artery stroke since it is the result of blood clots originating in the venous system.) As ScubaDoc mentioned, this is exactly what could occur with decompression gas bubbles, since they would move from the venous to the arterial circulation.
This aspect is being closely followed here at NASA since there is some indication that recumbency (all individuals in space are recumbent with respect to gravity) exacerbates the possibility of passage of decompression bubbles (formed during EVA) through the PFO. Likewise, immersion in water (blood flow shifts to the thoracic cavity) would be a contributing factor in arterialization (especially with coughing or a Valsalva maneuver, both of which promote rebound flow). One could well have another time bomb in the making. :boom:
Unless one had a saline contrast ultrasound exam (either by transesophageal or transcranial Doppler, not transthoracic echo), this arterialization mode could not be discounted. This viewpoint simply serves to underscore what ScubaDoc said earlier.......
______________________
Michael Powell, PhD (Dr Deco)
[sp]"There is also the consideration that the CVA might have been due to the passage of venous emboli across a septal defect, a situation that could be replicated by the venous bubbling that occurs in most divers on ascent."
The aspect of passage of blood clots through a patent foramen ovale (PFO) is very well documented in the population as a whole. This is described as the cause of paradoxical stoke in some individuals. (It is also called vein-to-artery stroke since it is the result of blood clots originating in the venous system.) As ScubaDoc mentioned, this is exactly what could occur with decompression gas bubbles, since they would move from the venous to the arterial circulation.
This aspect is being closely followed here at NASA since there is some indication that recumbency (all individuals in space are recumbent with respect to gravity) exacerbates the possibility of passage of decompression bubbles (formed during EVA) through the PFO. Likewise, immersion in water (blood flow shifts to the thoracic cavity) would be a contributing factor in arterialization (especially with coughing or a Valsalva maneuver, both of which promote rebound flow). One could well have another time bomb in the making. :boom:
Unless one had a saline contrast ultrasound exam (either by transesophageal or transcranial Doppler, not transthoracic echo), this arterialization mode could not be discounted. This viewpoint simply serves to underscore what ScubaDoc said earlier.......
______________________
Michael Powell, PhD (Dr Deco)
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