Cerebral DCS vs. Spinal DCS

Common symptoms:

Distinguishing between spinal and cerebral manifestation of DCS is of academic interest only, and the treatment – emergency oxygen and hyperbaric therapy – is the same. Cerebral symptoms are present in 30 to 40 percent of neurological DCS cases, while spinal cord symptoms are found in 50 to 60 percent of neurological DCS cases.

How to tell the difference:

Spinal DCS is caused by spinal cord damage, most often in the thoracic segment. Patients complain of paresthesias (i.e., pins and needles) and sensory loss in the trunk and extremities, a tingling or constricting sensation around the chest or abdomen, ascending leg weakness that can range from mild to severe, lower back or pelvic pain and loss of bowel and/or bladder control. The neurological examination will often reveal weakness or paralysis of both legs and a partial or complete loss of sensation.

Cerebral DCS can occur alone or in combination with spinal DCS and manifests as confusion, weakness, headache, gait disturbance, fatigue, diplopia (i.e., double vision) or visual loss. The neurological examination may show hemiparesis (i.e., weakness on right or left side), dysphasia (i.e., disturbance of speech and language), loss of balance and difficulty with gait, partial loss of vision in both eyes and other focal signs. Behavioural and cognitive aspects of cerebral DCS may be persistent or slow to improve.

Special cases:

In the case of a mild spinal DCS injury, a diver may initially complain of lower back pain and bilateral leg numbness and yet still have normal strength and sensation.