Brain MRI Signal Abnormalities and Right-to-Left Shunting in Asymptomatic Military Divers

Gempp, Emmanuel; Sbardella, Fabrice; Stéphant, E.; Constantin, Pascal; Maistre, Sébastien de; Louge, Pierre; Blatteau, Jean-Éric

doi:10.3357/asem.2786.2010

Cited by 21 publications

(24 citation statements)

References 22 publications

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“…Several previous studies reported imaging findings associated with NDCS in high-altitude mountain climbing (1,12) and deep sea divers (11,15). High-altitude mountain climbers have been reported as having an increased preponderance of subcortical HWM lesions and enlarged Virchow-Robin spaces relative to normal controls.…”

Section: Discussionmentioning

confidence: 99%

Hyperintense White Matter Lesions in 50 High-Altitude Pilots With Neurologic Decompression Sickness

McGuire¹,

Sherman²,

Brown³

et al. 2012

Aviation, Space, and Environmental Medicine

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Introduction Neurologic decompression sickness (NDCS) can affect high-altitude pilots, causing variable central nervous system symptoms. Five recent severe episodes prompted further investigation. Methods We report the hyperintense white matter (HWM) lesion imaging findings in 50 U-2 pilot volunteers, and compare 12 U-2 pilots who experienced clinical NDCS to 38 U-2 pilots who did not. The imaging data were collected using a 3T magnetic resonance imaging scanner and high-resolution (1-mm isotropic) three-dimensional fluid-attenuated inversion recovery sequence. Whole-brain and regional lesion volume and number were compared between groups. Results The NDCS group had significantly increased whole brain and insular volumes of HWM lesions. The intergroup difference in lesion numbers was not significant. Conclusion A clinical episode of NDCS was associated with a significant increase in HWM lesion volume, especially in the insula. We postulate this to be due to hypobaric exposure rather than hypoxia since all pilots were maintained on 100% oxygen throughout the flight. Further studies will be necessary to better understand the pathophysiology underlying these lesions.

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Section: Discussionmentioning

confidence: 99%

Hyperintense White Matter Lesions in 50 High-Altitude Pilots With Neurologic Decompression Sickness

McGuire¹,

Sherman²,

Brown³

et al. 2012

Aviation, Space, and Environmental Medicine

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“…46 Historically, in asymptomatic divers, brain MRI scanning in some studies suggested increased white matter lesions in association with right-to-left shunting. 47,48 This has not been confirmed in all studies, however. 49,50 One study showed 29% of divers with a PFO suffering major decompression illness versus 6% without ( P = 0.016), with a further association between the size of PFO and decompression illness lasting longer than 24 hours.…”

Section: Indications For Pfo Closurementioning

confidence: 75%

Modern management of a patent foramen ovale

Kanaganayagam

Malik

2012

JRSM Cardiovascular Disease

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A patent foramen ovale (PFO) has been associated with medical conditions such as cryptogenic stroke, migraine with aura, and decompression illness. Whether closure of the PFO has clinical benefit has been suggested from registry studies, but not yet confirmed in multiple randomized trials. Methods of diagnosis of a PFO and a summary of the current evidence for treatment is presented and discussed as a guide to patient-centred decision-making.

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“…Arterialized gas emboli have been considered one of the main causes of decompression-related pathology. Recently, Gempp et al demonstrated that the proportion of hyperintense spots in compressed-air divers was closely related to the presence of a large RLS [16], as suggested by Knauth et al [17]. The presence of RLSs in divers is an important risk factor in cerebral DCI events.…”

Section: Discussionmentioning

confidence: 92%

Brain Damage in Commercial Breath-Hold Divers

Kohshi

Tamaki²,

Lemaître

et al. 2014

PLoS ONE

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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.

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Brain MRI Signal Abnormalities and Right-to-Left Shunting in Asymptomatic Military Divers

Abstract: Healthy military divers with a hemodynamically relevant RLS have an increased likelihood of cerebral hyperintense spots compared to age-matched normal subjects. The clinical relevance of these MRI signal abnormalities and their causal relationship with diving remain unclear.

Cited by 21 publications

References 22 publications

Hyperintense White Matter Lesions in 50 High-Altitude Pilots With Neurologic Decompression Sickness

Hyperintense White Matter Lesions in 50 High-Altitude Pilots With Neurologic Decompression Sickness

Modern management of a patent foramen ovale

Brain Damage in Commercial Breath-Hold Divers

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