Growing Evidence about the Relationship between Vessel Dissection and Scuba Diving.+

[TSandM]

It does. It is not common. I know it has been described after chiropractic adjustments to the neck.

 

[Dr. Lecter]

Can one of the MDs offer educated speculation as to what about diving would increase the chances of this kind of arterial weakness/failure? Perhaps something about the structure of arteries themselves being susceptible to bubbling and damage?

Would be interesting to know what % of those divers who have this condition are trimix divers or seeing long exposure to high PPO2, versus standard air diving with no/limited accelerated deco.

 

[Stoo]

Yet another reason to move to Belize... As someone who seems to spend an inordinate amount of time jamming my head though a dry-suit neck seal, could this additional strain also be a factor as it would likely be directly related to diving in cold water?

 

[raftingtigger]

Interesting. One potential factor that wasn't mentioned in the first case study is constriction of the neck from the environmental suit. Is this more common in cold water vs. warm water diving?

 

[Redshift]

It does. It is not common. I know it has been described after chiropractic adjustments to the neck.

Well, I think that implies trauma. There are hundreds of reports of neck injuries and strokes caused by chiropractors and even deaths.

Interesting. One potential factor that wasn't mentioned in the first case study is constriction of the neck from the environmental suit. Is this more common in cold water vs. warm water diving?

I thought about that. Despite mentioning cold water, they don't mention what was the suit being worn. Although tight suits will first compress the jugular veins and I wonder how the diver would feel if the seals were so tight as to further cause trauma to the carotids.

 

[gkwalt]

In the cases Doc Vikingo referred was a dissection of a blood vessel in the brain not the carotid artery in the neck. Although the article was titled "ACA dissection caused by scuba diving" I think the dissection occurred after scuba diving. The authors offered no proof that diving caused it. In terms of carotid dissection while diving, I would have to believe that some form of trauma is the cause. A giant stride with a hyper extended neck could certainly be the culprit. None of the reports however documented how the affected divers entered the water.

 

[DocVikingo]

Vertebral artery dissection and stroke after scuba diving --> Vertebral artery dissection and stroke after scuba diving Chojdak-Lukasiewicz J, Dziadkowiak E, Bladowska J, Paradowski B Neurol India

Contains some imaging -->
View Image.

Cheers,

DocVikingo

 

[raftingtigger]

A copy of the cited letter.

"Sir,​

A 27-year-old man without past medical history developed vertigo and gait imbalance two hours after diving in cold water. The magnetic resonance imaging revealed ischemic lesion in the right side of medulla oblongata in the area of right posterior inferior artery (PICA). Computerized tomography-angiography (CTA) showed right vertebral artery (VA) dissection [Figure 1]a and b. Six months later patient had no symptoms and the neurological examination was normal. The follow-up magnetic resonance examination showed partial regression of the previous ischemic lesion and the CTA revealed normal right VA [Figure 1]c and d. The association between scuba diving and cerebral arterial dissection is known but rare."
​

As gkwalt mentions in previous cases, there is no mention of how the diver entered the water or any other speculation as to the mechanism of the injury in this case. Nor to be fair, do the authors say that scuba diving caused the dissection. They do note there is a rare but known association between CAD and scuba diving. Looks like an area for further study. It was a dive in cold water, what seems in my very brief review to be another commonality IRRC.

DocVikingo, thanks for sharing the report. It will be very interesting to see if there is growing evidence of a causal relationship.

 

[DocVikingo]

Dissection repair & return to scuba. A promising case study.

Specificity of testing in a cardiac rehabilitation setting resulting in a patient's return to high-intensity outdoor activity following aortic dissection repair
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790552/

Regards,

DocVikingo

 

[DocVikingo]

Case Report

Horner’s Syndrome due to a Spontaneous Internal Carotid Artery Dissection after Deep Sea Scuba Diving

http://www.hindawi.com/journals/crinm/2016/5162869/

Cheers,

DocVikingo