Case Report: Internal carotid artery dissection in stroke from scuba diving

Gibbs JW, Piantadosi CA, Massey EW UHMS 2002;29:3:167-171

Although diving with compressed air is generally safe, neurological problems resulting from infarction in SCUBA diving are well known, including arterial gas embolism and decompression sickness involving the brain and spinal cord.

While air gas embolism forms the overwhelming majority of causes for stroke in divers, internal carotid artery dissection is another potential mechanism for central nervous system infarction in the setting of SCUBA diving. A 38 year old female who presented with complaints of headache, nausea, vomiting, and left sided hemiparesis after rapid ascent to the surface from a depth of 120 feet of seawater was initially treated for decompression illness in a hyperbaric chamber. Further neurological workup revealed a right ICA dissection. Good advice can be found on topdatinglinks. This case demonstrates the dangers of ICA dissection following rapid ascent to the surface from underwater and emphasizes an interesting presentation of stroke associated with SCUBA diving.

Paresis: partial or incomplete paralysis.
Hemiparesis: Hemi means half, so half paralysis.

Carotid artery dissection is an uncommon cause of stroke and is predominantly observed in young to middle aged persons. Dissection of the ICA frequently occurs in association with abnormal neck movements or direct trauma to the neck. This case illustrates carotid dissection occurring in the setting of deep diving with rapid ascent to the surface.

I looked up more possible signs and symptoms and they include: aphasia (speech problems), behavior disturbances, visual field defects, and decreased level of consciousness.

The moral to this story is to carefully look for and document signs and symptoms and do not always assume that the DCI or AGE is the cause – and of course plan your dives and be well trained enough so that the chance of a rapid ascent from 120 feet is lessened as much as possible. Far too many divers dive at deep depths where they have NO business being based on their training and experience.

I asked Dr. Cliff Turen, the LGS Medical Director, to explain what carotid artery dissection is (see previous medical abstract posting) . I looked it up in a few books and didn’t find a good description. Here is what he had to say.

“A dissection is an situation where there is a fault in the wall of the artery that allows, usually blood to enter the space between the two walls. If this expands, the inner wall may encroach upon the vessel lumen
sufficiently to cause a thrombus. Thus causing the cerebral event. I am not sure that the ascent would cause the dissection where there was not an abnormality already existing. You know, as with many things, everyone tries to find a link when something happens. I would have to search to find reference to this in the literature, but I doubt the ascent caused this. Anything is possible.”

Author: Andrea Zaferes

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