Neuro Presentation of DCS - unanticipated

[Zuela]

Hello!

Several months ago, I have been diving in Honduras, and believe I experienced Decompression Sickness symptoms to what seemed to be related to a potential PFO. However, I was tested via TEE and showed no signs of a PFO. In addition, I have eliminated allergic reaction to neoprene / all thioureas via patch test. The symptoms have been getting progressively worse over the past 3 years.

These symptoms have all been early in the diving trip, and well within "normal" non-deco diving limits, using a computer. Unfortunately, I was using a rented dive computer, so I do not have my exact profiles but have outlined the approximate plan below.


That said, I am able to describe the symptoms and general dive profile for the most recent diving trip (all dives on air), with the most severe:


1st Day:

1. Profile:
   • 60 mins bottom time, max depth ~60 ft., slow assent with a 10 minute stop ~20 ft, and 2 minutes at 15 ft.
2. Symptoms:
   • Red rash on arm/bicep; neuropathic pain and skin sensitivity on rash region (approximately 2-3 hrs post dive). Assumed allergic reaction to fabric/material.

Surface Interval: ~24 Hours


2nd Day:

1. Profile:
   • 1st dive: 60 mins bottom time, max depth ~80 ft., majority of dive ~50 ft. 5 minute stop ~ 20 ft, and 2 minutes at 15 ft.
   • 60 min surface interval
   • 2nd dive: 60 min bottom time, max depth ~55ft., 5 min stop ~20 ft, 2 minutes 15 ft.
2. Symptoms:
   • Red rash on thighs; neuropathic pain and skin sensitivity on rash region (approximately 2-3 hrs post dive);
   • Red rash on trunk / abdomen; neuropathic pain and skin sensitivity on rash region (3-5 hrs post dive);
   • Scintillating scotoma (4-5 hrs post dive) which included mild nausea as it progressed;
   • Migraine, nausea, severe discomfort 5 hrs and continued through the night.

This recent event has me out of the water until I am able to identify the cause, and am uncertain the next steps to take.

I am happy to provide any and all additional information I may have. All recommendations will be greatly appreciated.

Thank you.
Dan

 

[Duke Dive Medicine]

Dan,

Can you clarify when these dives were and when the symptoms set in? You said that several months ago you made these dives in Honduras and had symptoms, then in the same paragraph you say they've been getting worse over the past three years. Do you mean that you've been experiencing these symptoms during dives for the past three years and you're just describing the most recent incident? If so, how long do the symptoms persist after each incident? Was the TEE performed with bubble contrast? Where was it done?

Thanks,
DDM

 

[Zuela]

Apologies for the confusion.

I have been having similar symptoms for the past three years, and have since limited my underwater exposure. I (incorrectly) assumed they were initially due to:

• unrelated sickness
  • symptoms: skin tenderness around abdomen/chest area; NO migraine; no further underwater exposure
  • duration: a few hours; symptoms were unpleasant but not debilitating
  • timeframe: three years ago

• skin allergy
  • family history: mother is allergic to neoprene, wears fleece suit when diving; patch test showed no allergies, but doctor diagnosed me with moderate dermatographia
  • symptoms: scintillating scotoma leading to loss in peripheral vision (common with my previous migranes non-diving related); migrane; skin sensitivity/neuropathic pain across abdomen; no further underwater exposure
  • duration: a few hours/ gone by morning; symptoms were unpleasant but not debilitating
  • timeframe: two years ago

• PFO
  • TEE was done specifically to explore the likelihood of a PFO, and done with bubble contrast. This was performed in Brooklyn, NY at Methodist Hospital.
  • this was the most recent, and detailed dive plan in original post

The most recent dives were close to a year ago at this point, and I was only describing the most recent, and most severe (by far) incident. Symptoms of recent first day dive lasted a couple hours and were uncomfortable but not debilitating. Since underwater exposure was very limited on this dive, I assumed it could not be DCS and proceeded to dive following day, especially since symptoms did not last very long. Symptoms from the second dive lasted several hours and were extremely debilitating due to migrane, vomiting, severe discomfort due to skin sensitivity/neuropathic pain across thighs and abdomen. This event is what prompted more extensive research, and at guidance from a dive master, began considering PFO.

As a broader understanding, I have been diving without any incident for over 10 years until the first occurrence 3 years ago. The incident 3 years ago was very sudden / unexpected and have (to me) progressed significantly/exponentially.

I hope this helps clarify my original post!! Happy to provide any additional info.

Thanks!!
Dan

 

[Zuela]

Also, if anyone happens to know of a good physician specialist with dive medicine experience in the NYC area, that would be greatly appreciated!

Thanks again!!
Dan

 

[Duke Dive Medicine]

Dan,

Look up Dr. Owen O'Neill in Sleepy Hollow, New York. He's with Westchester Hospital hyperbarics.

Best regards,
DDM