Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water

Abstract

Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation.Dive-related injuries are relatively common and mostly occur in recreational or scuba diving. Decompression illness (DCI) is a term used to describe illness resulting from a reduction in the ambient pressure surrounding the body. DCI encompasses decompression sickness (DCS) and arterial gas embolism (AGE). 1 When severe diving injury occurs, the nervous system is frequently involved. 2 We report 2 children with central nervous system complications after breath-hold diving in shallow water. CASE REPORTS Patient 1A previously healthy 12-year-old boy presented with unilateral leg weakness and paresthesia. Two days earlier, he had practiced repeated diving beneath the water surface for a distance of 25 m. He reports that, after ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. During the following hours, he subsequently experienced progressive sensory changes affecting his right side. This was followed by acute right leg weakness later the same day. A cerebral and lumbar spinal MRI that was ordered by the community neurologist on the next day was reported normal and he was discharged from the hospital. Two days later, the patient was referred to our hospital with persistent right leg weakness and paresthesia and an inability to walk. Neurologic examination revealed right leg weakness and sensory deficits with

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