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

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Wow...

Doc, I love you but my inner hypochondriac is going nuts right now.

Are these 'dissections' potentially fatal? Can they rupture? Can they grow to the size of a watermelon?

What happens if they go untreated?

First IPE, now this!

Doc! comfort me please!
 
Is there any possibility of a summary using lay terms so that the general audience can understand it better?
 
Doc, I love you but my inner hypochondriac is going nuts right now...Comfort me please!

You crack me up, tech_diver.

Q1. Are these 'dissections' potentially fatal? Can they rupture? Can they grow to the size of a watermelon?

A1. Carotid artery dissection begins as a tear in one of the carotid arteries of the neck, allowing blood to enter the wall of the artery and split its layers. This can result in a hematoma between the arterial layers, aka a pseudoaneurysm, which can result in varying degrees of occlusion of blood flow and be a source of blot clots, with possible resulting obstructive stroke. And, yes, while it is not common, a pseudoaneurysm can rupture, with very grim result.

On the bright side, reported mortality for spontaneous internal carotid artery dissection is <5% & ~75% of patients make a good recovery. OTOH, dissections secondary to trauma have a much higher rate of mortality & morbidity. Given blunt trauma, 37-58% of patients have permanent neurologic deficits.

So, in that sense it's important which type of dissection one suffers. It seems to be the general practice to diagnose traumatic carotid artery dissection only when significant blunt (or penetrating) injury can be identified. However, IMHO there is a worrisome band of uncertainty between the spontaneous and traumatic variety.

The dissection described the chap in the article posted above, which is by no means the only published case of carotid artery dissection post-scuba, is a splendid example of what I mean. Was it spontaneous (i.e., without any identifiable cause such as trauma or arterial disease which could explain it) or was it traumatic (e.g., the result of stretching of the internal carotid artery secondary to positioning of the neck to facilitate equalization of the ears or to look upwards, or a too rapid ascent from depth)? He had only one reported risk factor, and a minor one at that, benign arterial hypertension. Yet, there also was no clear history of blunt or penetrating trauma to the artery.

Q2. What happens if they go untreated?

A2. Once one starts to manifest the signs & symptoms of cervical carotid dissection, it's quite unlikely s/he would not receive appropriate medical attention.

In general, this type of dissection can be conservatively managed with excellent anatomic & symptomatic resolution and low rates of recurrence. Management typically is by the use of anticoagulation (e.g., Coumadin (warfarin)) or antiplatelet (e.g., aspirin)) therapy. The patient in the linked case study was treated with aspirin and in fact did show such resolution.

Responsive?

Regards,

DocV

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

---------- Post added November 1st, 2013 at 08:02 AM ----------

Is there any possibility of a summary using lay terms so that the general audience can understand it better?


Hi boulderjohn,

I appreciate the difficulty heavy medical terminology poses to the lay individual.

In my reply to tech_diver immediately above I endeavored mightly to express the topic in as clear & simple terminology as I could without doing gross injustice to the basics.

Did I do good?

Cheers,

DocV
 
Hi boulderjohn,

I appreciate the difficulty heavy medical terminology poses to the lay individual.

In my reply to tech_diver immediately above I endeavored mightly to express the topic in as clear & simple terminology as I could without doing gross injustice to the basics.

Did I do good?

Cheers,

DocV
Good enough for me--thanks!
 
John Ritter died of an aortic dissection. That type is usually associated a hereditary weakness in the artery wall, hardening of the arteries, and hypertension. Dissections in the neck arteries are more often caused by trauma and is an important cause of stroke in young people. Some folks with dissections may also have a abnormality of the vessel wall called fibromuscular dysplasia. I have read many of the articles related to cervical artery dissection in divers. The one piece of missing information in the reports is how the diver entered the water. Over the years I have witnessed many less than graceful giant strides off of boats. Since the signs and symptoms of carotid or vertebral artery dissection may not show up immediately, the problem may be related to a violent force on the neck while entering the water. Although divers are taught to look straight ahead when doing the giant stride, many look at the water and can subject their necks to blunt trauma.
As a p.s. I suffered a carotid dissection about 15 years ago while water skiing. Now I switched to something a lot safer...scuba diving!
 
Great case. If we had better data on the number of active divers, it would be interesting to compare the rate of occurrence of carotid artery dissection in divers with that in the general population and see if there's really a difference.
 
J Stroke Cerebrovasc Dis. 2014 Apr 29. pii: S1052-3057(14)00103-7. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.016. [Epub ahead of print]

A Case of Anterior Cerebral Artery Dissection Caused by Scuba Diving.

Fukuoka T1, Kato Y2, Ohe Y2, Deguchi I2, Maruyama H2, Hayashi T2, Tanahashi N2.

Author information 1Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan. Electronic address: tfukuoka@saitama-med.ac.jp.2Department of Neurology, Saitama Medical University International Medical Center, Saitama, Japan.

Abstract

A 51-year-old man was admitted with right hemiparesis during scuba diving, without headache. Brain magnetic resonance (MR) imaging depicted high-intensity areas in the left superior frontal and cingulate gyri on diffusion-weighted imaging. Dissection of the anterior cerebral artery (ACA) was detected using axial MR angiography and 3-dimensional MR cisternography. Dissection of the ACA during and after scuba diving has not been reported before. Dissection of the arteries should be included in the differential diagnosis when neurologic symptoms occur both during and after scuba diving, even if the patient does not experience headache. Furthermore, the combination of MR cisternography and MR angiography is useful to detect ACA dissection.”
 
If we had better data on the number of active divers, it would be interesting to compare the rate of occurrence of carotid artery dissection in divers with that in the general population and see if there's really a difference.

But does this occur in the general population in the absence of trauma?
 
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