Growing Evidence about the Relationship between Vessel Dissection and Scuba Diving

Abstract

Carotid and vertebral artery dissection are relatively frequent and risky conditions. In the last decade, different patients with extracranial (and in 1 case also intracranial) dissections associated with the practice of scuba diving were reported. The connection between the two conditions has not been fully explained so far. In the present article, we report the case of a patient presenting with Claude Bernard-Horner syndrome and homolateral XII cranial nerve palsy, manifesting a few days after diving in the cold water of a lake. The patient ended up having internal carotid artery dissection associated with the formation of a pseudoaneurysm. Here, we offer a summary of all cases reported in the literature about scuba diving and arterial dissection, and provide a critical discussion about which scuba diving-related factors can trigger the dissection of cervical vessels.

Cerebrum-cervical arterial dissection in adults during sports and recreation

“…Dissection of the following carotid arteries was observed: internal (eleven cases), external ( four cases) and common ( five cases). A list of the arteries affected in each case, along with the clinical manifestations according to the Bamford classification 25 , is presented in Table. In nine cases, the dissection occurred in the intracranial segment of the arteries, while in 30 cases it affected the extracranial segment. In two cases, both intra-and extracranial segments were affected.…”

“…A comprehensive review of the literature showed that, so far, only isolated cases or small series have been publish ed 2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24 . Of all the sports potentially related to cerebrum-cervical arterial dissection, scuba diving 25 and martial arts 20,21,22 are those that are most often mentioned in the literature. This was not the experience of the authors of the present paper, who found that jogging was the main activity temporally related to arterial dissection among our patients.…”

Vertebral artery dissection and stroke after scuba diving

“…[1,2] Repetitive strain on the interspinous ligaments is thought [1,2] Repetitive strain on the interspinous ligaments is thought…”

Delayed recognition of Horner syndrome secondary to internal carotid artery dissection after scuba diving

“…Over the last 20 years, there have been a small yet increasing number of case studies reporting a link between dissection of the cervical blood vessels and scuba diving . The majority of cases have presented immediately after the diving episode or within 2 weeks to emergency services.…”

“…There are relatively few cases of ICA dissection secondary to scuba diving, as summarized by Brajkovic et al . Furthermore, Horner syndrome occurring within this context is an even rarer event .…”