ANALYSIS

Brain injury can result from external trauma (blunt injury, falls) or from interruptions in blood flow within the brain. The latter of these is known as a cerebrovascular accident (CVA) or stroke, which is what the doctors first suspected when the diver showed up at the hospital. The fact that this diver also had the symptom of tongue deviation was another possible indicator that the diver had experienced a stroke, as the mechanism is similar with bubbles obstructing the blood flow to parts of the brain. However, it is likely this doctor was not familiar with diving medicine. After testing, stroke was ruled out and the diver was diagnosed with Type II DCS.

Symptoms of Type II DCS are considered more serious. They typically fall into three categories: neurological, inner ear and cardiopulmonary. Neurological symptoms may include: numbness, pins and needles or tingling (paraesthesia), an altered sensation, muscle weakness, an impaired gait, or difficulty walking, problems with physical coordination or bladder control, paralysis or a change in mental status, such as confusion or lack of alertness.

Divers are sometimes assessed by a neurologist before being treated for DCI to rule out CVA.

Type II symptoms can develop at different speeds. A slow buildup can obscure the seriousness of the situation by allowing denial to persist. Less common symptoms, such as difficulty walking, urinating, hearing or seeing – especially if their onset is quick – can prompt faster recognition and action.

Fortunately, the diver in this case acted fast and requested help at the first onset of symptoms, so he was able to receive prompt treatment and ultimately, he recovered well.