Stroke & Diving

[Vincent Vega]

Hi everyone,

I've been mulling over the idea of taking a PADI OW course, however I have a slightly unique situation. Let me preface this question with a disclaimer first though, so I can avoid the inevitable responses. Yes, I know you might not be doctors, and yes, I have already seen several doctors, neurologists and neurosurgeons. Oh, and yes I used the search function, and came up empty handed.

Anyways here goes. Last year I turned 30, and I became a stroke survivor. I was (and am returning to being) extremely active, and in good physical condition. During the course of my life (possibly lifting weights or during a Yoga class) I developed a dissection(tear) of my left vertebral artery. A thrombus(clot) formed, and subsequently was dislodged, moved into my cerebellum and I had a series of 3 ischemic cerebellar strokes, the worst of which left me unable to walk, speak or see. My condition improved rapidly after diagnosis and treatment, and now one year later after my Warfarin therapy is over, I have no lasting ill effects aside from a very slight loss of peripheral vision and minor narrowing of the affected (and now healed) artery. I am also sentenced to daily 81 mg Aspirin for the rest of my time above ground. Phew.

OK, so now here's my question. Do those of you with experience know of any reason why SCUBA might not be safe or advisable for me? I have asked my GP, Neurosurgeon and Neurologist this exact question, and have been met with blank stares. All I have been medically advised against is any activity which might agravate my previously injured artery. (Think whiplash...contact sports, bungee jumping etc etc)

Please bear in mind that I know virtually nothing about SCUBA, except that I have a basic understanding of air/gas embolism, and I am aware that it can be a concern for divers. Other than that I'm just a newb who is really excited to learn to dive.

Sorry for the long post. Thanks for reading.

-VV

*I do intend to have this conversation with the PADI instruction when I'm able to!*

 

[300bar]

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A ScubaBoard Staff Message...

Moved to the place the Doc's do hang out.

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[Vincent Vega]

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A ScubaBoard Staff Message...

Moved to the place the Doc's do hang out.

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Yikes! Sorry about that - Should have looked around more first. *shame*

 

[300bar]

Yikes! Sorry about that - Should have looked around more first. *shame*

Don't be,Doc's will be comming along soon

 

[Vincent Vega]

OK so still no replies, but I have a bit of new & somewhat encouraging info.

I'd still like to hear from someone with actual experience though.

I spoke to another Neurologist today (the one who treated me in the emergency room initially last year) and he told me he thought I should have no problems with 2 atmospheres of pressure. He wasn't willing to explain where he came up with this number, or what might happen if I exceeded it, but I'm used to Neuros and their non-committal ways by now

Anyways, I guess it's better than nothing. Still like to hear from the voice of experience though, if even to clarify why my Neuro might have given me this info.

Cheers.

 

[herman]

Welcome to the board. I don't remotely qualify to give medical advise but while you are waiting on Doc, you should contact DAN- the Divers Alert Network. They are pretty much the authority on dive medicine. DAN Divers Alert Network
They have a contact info on the left hand side of the page.
Good Luck and if it's any help, one of my dive buddies was cleared to dive after a stroke and another buddy was cleared to dive 3 months after triple bypass so there is hope.

 

[TSandM]

Did you have any underlying genetic problem that led to the dissection, or was it traumatic?

If the artery has healed and there is no further thrombus, there is no reason to believe that pressure changes will do anything to it. It's fluid-filled, and will equilibrate to ambient pressure within and without, so there is no change in transmural pressure.

The neck extension position assumed by a horizontal diver does bend the vertebral artery, but unless the narrowing is marked, you should tolerate that just fine. You might try lying on a floor and extending your neck until you can see in front of you, and see if you have any visual changes or altered level of consciousness -- that would be a reasonable provocative test, and safe.

If this was related to high blood pressure, it needs to be controlled (but I assume that has been done, if it was necessary, as you did not mention it.)

No physician is going to tell you it is absolutely safe to dive (not even me!) because of liability concerns, and the fact that there is no available information with which to answer your question. The set of young people with vertebral dissections who survive without major neurologic abnormalities is extremely small, and you may be unique in the intersection of that set with the set of people who dive. So nobody has a study to use to base a recommendation upon, and nobody feels safe telling you it's okay. I won't, either, but I will tell you that I am unaware of anything about diving that should aggravate your problem EXCEPT neck position, or any underlying disease process that led to the dissection in the first place.

 

[IceBergSlim]

I do know of one board member that dives often in spite of having had a stroke when she was quite young. It does not seem to slow her down at all.

Of course that is hardly real medical advice but I thought you might find it encouraging.

 

[Dr. Doug Ebersole]

I'm a cardiologist, not a neurologist, but I agree with Lynne (TSandM) above that, while diving is always associated with risk, there should be no reason to think diving for you is contraindicated. Unfortunately, there is simply no data on diving and your condition. Was a reason found for the spontaneous dissection? Severe hypertension? Other associated conditions with dissections would be Marfan's or Ehlers-Danlos Syndromes. These are extremely rare but I thought I'd mention it in case your doctors had mentioned them to you.

DAN (DAN Divers Alert Network) is always a great resource in this regard.

Best of luck.

 

[Vincent Vega]

Thanks for the replies everyone.

TS&M & Debersole - The dissection was indeed traumatic - iirc the doctors in the ER suspected forced neck flexion as the culprit as I had been active in grappling for several years leading up to the event, as well as seeing a chiro for neck adjustments regularly (I don't anymore) and in fact my "big" stroke occured right on the mats during a BJJ class while I was on the receiving end of an arm triangle choke.

I did undergo genetic testing as a precaution however, and Marfans and several other connective tissue disorders with names I cannot recall were also ruled out.

I am aware of the issues with neck position and I don't believe that will be a problem - I did several long-ish snorkelling sessions this summer to test my neck, and I had not a single problem, and no neurological symptoms, so I guess that is good news.

I think based on this info and what I've learned from doctors on my end that I'm going to at least do the classroom and pool sections of the PADI course in November, and I'll make the decision about my open water dives based (probably not till next spring owing to the nasty winter here) on how I do in the pool.

Cheers!