BackgroundAcute decompression illness (DCI) involving the brain (Cerebral DCI) is one of the most serious forms of diving-related injuries which may leave residual brain damage. Cerebral DCI occurs in compressed air and in breath-hold divers, likewise. We conducted this study to investigate whether long-term breath-hold divers who may be exposed to repeated symptomatic and asymptomatic brain injuries, show brain damage on magnetic resonance imaging (MRI).Subjects and MethodsOur study subjects were 12 commercial breath-hold divers (Ama) with long histories of diving work in a district of Japan. We obtained information on their diving practices and the presence or absence of medical problems, especially DCI events. All participants were examined with MRI to determine the prevalence of brain lesions.ResultsOut of 12 Ama divers (mean age: 54.9±5.1 years), four had histories of cerebral DCI events, and 11 divers demonstrated ischemic lesions of the brain on MRI studies. The lesions were situated in the cortical and/or subcortical area (9 cases), white matters (4 cases), the basal ganglia (4 cases), and the thalamus (1 case). Subdural fluid collections were seen in 2 cases.ConclusionThese results suggest that commercial breath-hold divers are at a risk of clinical or subclinical brain injury which may affect the long-term neuropsychological health of divers.
Summary:The purpose of this study was to clarify the influence of different vibration frequencies on wakefulness level. Subjects were 7 healthy male university students aged 21.9±1.6 years (mean). All students were non-smokers. Three exposure conditions were used (10 Hz vibration, 20 Hz vibration, and no vibration). Wholebody vertical vibration was applied to subjects sitting on a car passenger seat using a whole-body vibration shaker (CV-300, Akashi) at a single frequency (10 or 20 Hz) at an acceleration level of 0.3 ms -2 r.m.s. for 24 min. The objective wakefulness level based on EEGs was evaluated in terms of the alpha attenuation coefficient (AAC) obtained by the Alpha Attenuation Test (AAT). As parameters of psychological stress, salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA) were used. The subjective wakefulness level was evaluated using a questionnaire based on the Kwansei Gakuin Sleepiness Scale (KSS), which is a scale developed for the Japanese based on the Stanford Sleepiness Scale (SSS). The KSS score, representing the subjective wakefulness level, decreased after the exposure irrespective of the exposure condition, but the decrease was not significant. The AAC, representing the objective wakefulness level, significantly decreased only after vibration exposure (10 Hz/20 Hz) but did not differ between the two vibration frequencies. No significant changes were observed after exposure to whole-body vibration in MHPG or HVA as parameters of vibration-related stress. The AAC decreased after exposure to whole-body vibration (10 Hz/20 Hz), suggesting a decrease in the wakefulness level. However, no differences were observed in the influence of the two different vibration frequencies test.
Intravascular bubbles may be formed after repetitive breath-hold dives with short surface intervals or after a long breath-holding session in Ama divers. Symptoms consistent with neurological accidents in repetitive breath-hold diving may be caused in part by the intravascular presence of bubbles, indicating the need for safety procedures.
Nitrogen (N2) accumulation in the blood and tissues can occur due to breath-hold (BH) diving. Post-dive venous gas emboli have been documented in commercial BH divers (Ama) after repetitive dives with short surface intervals. Hence, BH diving can theoretically cause decompression illness (DCI). “Taravana,” the diving syndrome described in Polynesian pearl divers by Cross in the 1960s, is likely DCI. It manifests mainly with cerebral involvements, especially stroke-like brain attacks with the spinal cord spared. Neuroradiological studies on Ama divers showed symptomatic and asymptomatic ischemic lesions in the cerebral cortex, subcortex, basal ganglia, brainstem, and cerebellum. These lesions localized in the external watershed areas and deep perforating arteries are compatible with cerebral arterial gas embolism. The underlying mechanisms remain to be elucidated. We consider that the most plausible mechanisms are arterialized venous gas bubbles passing through the lungs, bubbles mixed with thrombi occlude cerebral arteries and then expand from N2 influx from the occluded arteries and the brain. The first aid normobaric oxygen appears beneficial. DCI prevention strategy includes avoiding long-lasting repetitive dives for more than several hours, prolonging the surface intervals. This article provides an overview of clinical manifestations of DCI following repetitive BH dives and discusses possible mechanisms based on clinical and neuroimaging studies.
Decompression illness in breath‐hold diving is a rare dysbaric disease mainly characterized by stroke‐like neurological disorders. The early use of DWI‐MRI combined with ADC map in suspected cases can help in the early diagnosis and treatment.
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