Subtle Post Dive Neurological Symptoms

[CGE925]

I'm a 57 year old male in reasonable shape, very well controlled BP, no other apparent conditions that would cause concern with my diving. Had my right hip replaced two years ago. Returning to the boat after a recent dive, in slightly rough water and after a particularly great bout of exertion twisting and bending to remove my fins, within perhaps a minute of climbing up the ladder, I was hit with a very unusual and obvious sense of confusion and short term memory loss. Although very subtle, I also noticed some double vision and a reduction in peripheral vision/dead zone on my right side. I was walking and talking quite normally and had NO other symptoms whatsoever. Six hours on, the symptoms had greatly abated but were still barely discernable, and 24 hours on, the only sign was a lingering issue with memory, which had continued to lessen and disappeared within a week. Now, I am definitely exactly as I was before that dive. I downloaded the dive off my wrist computer and studied it, and there was nothing that was outwardly concerning. The total time was only 45 minutes, max depth only 62 feet and that for only a few minutes; average depth 30-40 ft if that. The ascent rate was a bit quick at the end, as I was running VERY low on air; I had allowed the guide to bring us back to the boat well below my usual 500PSI limit, and so I did not do a safety stop.

I immediately went to my GP, and she could find nothing. We are starting with an MRI, and I will ask for the carotids to be Dopplered. She said they sounded fine through the stethoscope, but I do have an issue with the LH side; I had surgery and radiation for a Parotid tumor 15 years ago and have scar tissue in my neck which causes me some discomfort if I bend my neck in certain ways. I may also suggest she send me for an echocardiogram. I would appreciate your thoughts and comments on what possibly could have caused this. Could a TIA, embolism, etc, have resulted in such subtle symptoms? I'm not about to dive again until it's sorted out, which is causing me to miss my LDS's New Years ice dive and probably their Bonaire trip in March as well. My big worry is that it was so subtle and temporary that the cause may never be found or rectified, so I won't know with certainty whether I can ever dive again, And that means I can't. :depressed:

 

[flots am]

Call Diver's Alert Network and ask them. In fact, have your doctor call them.

Wasting time by guessing and running tests that won't pick up DCS may make things harder/impossible to treat.

Join or Renew DAN Scuba Diving Membership, Contact DAN ? DAN | Divers Alert Network

1-919-684-9111

Now, I am definitely exactly as I was before that dive.

Sorry, I missed that part.

You probably still want to figure out what this is so it doesn't happen again.

flots.

 

[DocVikingo]

Could a TIA, embolism, etc., have resulted in such subtle symptoms?

Hi CGE925,

Yes, an occlusive event affecting the vasculature of the neck or head indeed could present with subtle or alarming transient confusion, short-term memory loss & disturbances of vision.

TIAs often, but not always, also involve weakness, numbness or paralysis on one side of the body, dizziness or loss of balance or coordination, or altered speech. The sxs customarily clear quite rapidly, often only lasting minutes but almost always resolving within an hour or two. Given a situation where "Six hours on, the symptoms had greatly abated but were still barely discernable, and 24 hours on, the only sign was a lingering issue with memory, which had continued to lessen and disappeared within a week," one might suspect another, but kindred vascular process.

You are doing the right thing by seeking a thorough evaluation of this event. If your GP appears stumped, you may wish to consider asking for an evaluation by a neurologist.

Please keep the forum appraised of your test findings & progress.

Best of luck.

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[CGE925]

Hi CGE925,

Yes, an occlusive event affecting the vasculature of the neck or head indeed could present with subtle or alarming transient confusion, short-term memory loss & disturbances of vision.

TIAs often, but not always, also involve weakness, numbness or paralysis on one side of the body, dizziness or loss of balance or coordination, or altered speech. The sxs customarily clear quite rapidly, often only lasting minutes but almost always resolving within an hour or two. Given a situation where "Six hours on, the symptoms had greatly abated but were still barely discernable, and 24 hours on, the only sign was a lingering issue with memory, which had continued to lessen and disappeared within a week," one might suspect another, but kindred vascular process.

You are doing the right thing by seeking a thorough evaluation of this event. If your GP appears stumped, you may wish to consider asking for an evaluation by a neurologist.

Please keep the forum appraised of your test findings & progress.

Best of luck.

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Thanks very much for the quick responses. My GP is a wonderful lady and immediately initiated contact with her "local" Neurologist, but I haven't yet heard back from her. She's probably waiting for the the initial test, the MRI, which is booked for tomorrow afternoon (gotta love the Group Insurance ;o) To reiterate, the only physical symptom I could notice initially was the "empty brain" and memory confusion, absolutely no weakness, numbness, balance issues or any other sign that anything was amiss. The vision problems were so subtle it took me a good 30 minutes to even be aware of them. No one on the boat, including the captain I chatted with for an hour after I thumbed the second dive, was in any way aware of what was happening. The memory "problems", later that day and for the following few days were no more than struggling to remember basic but non-routine tasks like how to log on to ship's WiFi on the cruise ship we were on. Five days after the event, they had subsided to things like taking two seconds to remember our home phone number or Zip code, which ordinarily would have been instantaneously remembered. After a week, everything was completely normal.

I'm keeping all fingers and toes crossed that this can be identified and resolved. I will be happy to report back.

 

[Duke Dive Medicine]

Did you have any dives leading up to this one? From the profile I agree that DCS is unlikely but the symptoms and presentation time make me wonder. It's not altogether impossible for you to have shunted some bubbles. Chest films to look for sources of air trapping in your lungs would be reasonable to consider as well. Other causes not related to diving should certainly be ruled out and it looks like you are pursuing that. I'll be interested to hear your test results.

Best regards,
DDM

 

[CGE925]

Did you have any dives leading up to this one? From the profile I agree that DCS is unlikely but the symptoms and presentation time make me wonder. It's not altogether impossible for you to have shunted some bubbles. Chest films to look for sources of air trapping in your lungs would be reasonable to consider as well. Other causes not related to diving should certainly be ruled out and it looks like you are pursuing that. I'll be interested to hear your test results.

Best regards,
DDM

This was the first dive of the day, and I hadn't been down in weeks. Would chest X rays show anything useful at this point, given that the event happened weeks ago?

The more I think of this episode, I am beginning to notice another symptom that I have begun to experienced over the last few years. With no warning and seemingly no little or action on my part, I will experience a very noticeable light-headedness. It's the sort of feeling that many people, myself included, experience when they bend over and then stand upright too quickly, but will be more pronounced. In my case, it will last never more than a few seconds, but will be severe enough that when I experience one, I will grab the nearest handhold, stop and close my eyes until it passes. Never any spinning, vertigo, dizziness, etc, just a feeling that I could faint, though I never have. I had not experienced one of these episodes anywhere near the time of this dive. I did report this to my GP and it's in her copious notes on the case.

Thanks for the interest, much appreciated

 

[DocVikingo]

The more I think of this episode, I am beginning to notice another symptom that I have begun to experienced over the last few years. With no warning and seemingly no little or action on my part, I will experience a very noticeable light-headedness. It's the sort of feeling that many people, myself included, experience when they bend over and then stand upright too quickly, but will be more pronounced. In my case, it will last never more than a few seconds, but will be severe enough that when I experience one, I will grab the nearest handhold, stop and close my eyes until it passes. Never any spinning, vertigo, dizziness, etc, just a feeling that I could faint, though I never have. I had not experienced one of these episodes anywhere near the time of this dive.

What you are describing is almost certainly orthostatic hypotension & doesn't seem to be serious enough to warrant extensive evaluation at this time, although it definitely is worthy of mention to your treating sources. Many people occasionally feel dizzy or lightheaded after standing/moving upright after bending over. You indicate that your BP is very well controlled, and I'm going to assume that an antihypertensive(s) of some sort is involved. In this regard, medications used to treat HBP, such as diuretics; alpha, beta & calcium channel blockers; angiotensin-converting enzyme (ACE) inhibitors; & nitrates can be associated with orthostatic hypotension.

This was the first dive of the day, and I hadn't been down in weeks. Would chest X rays show anything useful at this point, given that the event happened weeks ago?

Sources of air-trapping in the lungs that can imaged by chest x-ray include asthma & emphysema, although it is unlikely that you could have a meaningful case of either of these in the absence of any breathing issues. Cystic air-spaces known as bullae or blebs are often associated with COPD conditions like emphysema, but on occasion may also be found in healthy people with no other medical issues.

Regards,

DocVikingo

 

[Duke Dive Medicine]

This was the first dive of the day, and I hadn't been down in weeks. Would chest X rays show anything useful at this point, given that the event happened weeks ago?

The more I think of this episode, I am beginning to notice another symptom that I have begun to experienced over the last few years. With no warning and seemingly no little or action on my part, I will experience a very noticeable light-headedness. It's the sort of feeling that many people, myself included, experience when they bend over and then stand upright too quickly, but will be more pronounced. In my case, it will last never more than a few seconds, but will be severe enough that when I experience one, I will grab the nearest handhold, stop and close my eyes until it passes. Never any spinning, vertigo, dizziness, etc, just a feeling that I could faint, though I never have. I had not experienced one of these episodes anywhere near the time of this dive. I did report this to my GP and it's in her copious notes on the case.

Thanks for the interest, much appreciated

What you've described may be orthostatic hypotension as DocV noted. If it is, it's probably unrelated to your symptoms after your dive. It was definitely worth mentioning to your GP in the setting of your other neurological symptoms, though.

Best regards,
DDM

 

[CGE925]

I'm a 57 year old male in reasonable shape, very well controlled BP, no other apparent conditions that would cause concern with my diving. Had my right hip replaced two years ago. Returning to the boat after a recent dive, in slightly rough water and after a particularly great bout of exertion twisting and bending to remove my fins, within perhaps a minute of climbing up the ladder, I was hit with a very unusual and obvious sense of confusion and short term memory loss. Although very subtle, I also noticed some double vision and a reduction in peripheral vision/dead zone on my right side. I was walking and talking quite normally and had NO other symptoms whatsoever. Six hours on, the symptoms had greatly abated but were still barely discernable, and 24 hours on, the only sign was a lingering issue with memory, which had continued to lessen and disappeared within a week. Now, I am definitely exactly as I was before that dive. I downloaded the dive off my wrist computer and studied it, and there was nothing that was outwardly concerning. The total time was only 45 minutes, max depth only 62 feet and that for only a few minutes; average depth 30-40 ft if that. The ascent rate was a bit quick at the end, as I was running VERY low on air; I had allowed the guide to bring us back to the boat well below my usual 500PSI limit, and so I did not do a safety stop.

I immediately went to my GP, and she could find nothing. We are starting with an MRI, and I will ask for the carotids to be Dopplered. She said they sounded fine through the stethoscope, but I do have an issue with the LH side; I had surgery and radiation for a Parotid tumor 15 years ago and have scar tissue in my neck which causes me some discomfort if I bend my neck in certain ways. I may also suggest she send me for an echocardiogram. I would appreciate your thoughts and comments on what possibly could have caused this. Could a TIA, embolism, etc, have resulted in such subtle symptoms? I'm not about to dive again until it's sorted out, which is causing me to miss my LDS's New Years ice dive and probably their Bonaire trip in March as well. My big worry is that it was so subtle and temporary that the cause may never be found or rectified, so I won't know with certainty whether I can ever dive again, And that means I can't. :depressed:

Status Update as at 16 January. I had an MRI before Christmas and just received the results. Surprisingly and worryingly, the results are positive though somewhat unclear as to their importance:

There are no previous examinations for comparison.

Findings : The cerebellum, the brain stem and the cerebral hemispheres show normal morphology. Adequate grey white matter differentiation. Normal size and shape of the ventricles.

Both orbits and contents, the C.P. angles and internal auditory canals as well as the basal ganglia and cavernous sinuses are symmetric and unremarkable.

Minor inflammatory changes are present in the sphenoid sinus and in the left mastoid bone.

There are two areas which are compatible with infarcts, not acute but possibly subacute located in the left occipital lobe, in posterolateral location and in the left parietal lobe in the area of the
superior parietal lobule. In the FLAIR sequence, there is diffuse slight hypersignal of the white matter in the centrum semiovale and the corono radiata extending to the optic radiations.

No other abnormalities are detected.

I also reviewed the dive profile in detail. Unfortunately, I had my computer set at the default sampling rate of 30 seconds, so the resolution is low, only two data points per minute. It does show a few exeedances of >30 fpm, but just barely (38 ft to 7 ft in 60 seconds for example; a young boy on the tour panicked and shot to the surface, so I followed them up rather than wait down low. I may have been a little over-eager to find out what was going on).

Next stop is at the Hyperbaric Medicine/Dive Doctor's office next month. Hopefully she will sort things out and clear me. I have to admit that my GP sure scared me when she postulated that the MRI results could bar me from diving again. Fortunately, she is very interested in helping me, and is clear that she what knows what she doesn't know, and will defer to the specialist. I sure hope a few seconds of inattention and newby stupidity on one dive hasn't killed off my diving forever...

 

[Duke Dive Medicine]

Thank you for the update. If you have an opportunity to post after you see the diving medical specialist, we'd be interested to hear what he/she says.

Best regards,
DDM