Gerriets Tibo, Tetzlaff Kay, Hutzelmann Alfred, Liceni Thomas, Kopiske Gerrit, Struck Niklas, Reuter Michael, Kaps Manfred
Department of Neurology, Justus-Liebig-University Giessen, Am Steg 20, 35390 Giessen, Germany.
Aviat Space Environ Med. 2003 Oct;74(10):1058-60.
Recent studies suggest that healthy sport divers may develop clinically silent brain damage, based on the association between a finding of multiple brain lesions on MRI and the presence of right-to-left shunt, a pathway for venous gas bubbles to enter the arterial system.
We performed echocontrast transcranial Doppler sonography in 42 sport divers to determine the presence of a right-to-left shunt. Cranial MRI was carried out using a 1.5 T magnet. A lesion was counted if it was hyperintense on both T2-weighted and T2-weighted fluid attenuated inversion recovery sequences. To test the hypothesis that the occurrence of postdive arterial gas emboli is related to brain lesions on MRI, we measured postdive intravascular bubbles in a subset of 15 divers 30 min after open water scuba dives.
Echocontrast transcranial Doppler sonography revealed a right-to-left shunt in 16 of the divers (38%). Only one hyperintensive lesion of the central white matter was found and that was in a diver with no evidence of a right-to-left shunt. Postdive arterial gas emboli were detected in 3 out of 15 divers; they had a right-to-left shunt, but no pathologic findings on cranial magnetic resonance imaging.
Our data support the theory that right-to-left shunts can serve as a pathway for venous gas bubbles into the arterial circulation. However, we could not confirm an association between brain lesions and the presence of a right-to-left shunt in sport divers.
近期研究表明，健康的职业潜水员可能会出现临床上无症状的脑损伤，这是基于MRI上发现多个脑病变与右向左分流（静脉气泡进入动脉系统的途径）之间的关联。
我们对42名职业潜水员进行了超声造影经颅多普勒超声检查，以确定是否存在右向左分流。使用1.5T磁体进行头颅MRI检查。如果病变在T2加权和T2加权液体衰减反转恢复序列上均为高信号，则计为一个病变。为了检验潜水后动脉气体栓塞的发生与MRI上的脑病变有关这一假设，我们在15名潜水员进行开放水域水肺潜水30分钟后，测量了他们体内的血管内气泡。
超声造影经颅多普勒超声检查显示16名潜水员（38%）存在右向左分流。仅发现一例中央白质高信号病变，该潜水员无右向左分流证据。15名潜水员中有3名检测到潜水后动脉气体栓塞；他们有右向左分流，但头颅磁共振成像未发现病理改变。
我们的数据支持右向左分流可作为静脉气泡进入动脉循环途径的理论。然而，我们无法证实职业潜水员脑病变与右向左分流之间的关联。
