Klien S, Spiegel M, Engelhardt K, Schmidauer C, Ulmer H, Diepers M, Schmutzhard E, Mutzbauer T
Department of Neurology, University Hospital Innsbruck, Austria.
Undersea Hyperb Med. 2005 Nov-Dec;32(6):403-7.
Menstruation has been described as risk factor for neurological decompression sickness in divers. In considering this for paradoxical gas embolism, we hypothesized that there may be a link between cycle-dependent hormonal changes and the manifestation of a right-to-left shunt (RLS).
40 women with a regular cycle of 28 days underwent transcranial Doppler sonography examinations (TCD) on day 1 and on day 15 of the menstrual cycle. Cerebral high intensity transient signs (HITS) proved a RLS.
We found a 25% RLS incidence consistent with the literature. In 7 of 10 shunt-positive women it was detected mainly or exclusively on day 15. This difference in PFO detection rate is statistically significant (p = 0.031), indicating more RLS during the peri-ovulatory period.
Our results do not support menstruation as a risk factor for neurological decompression sickness. The peri-ovulatory estrogen peak, which leads to systemic vasodilation, may explain our data. Factors that increase the risk for developing a RLS and thereby paradoxical embolism should be avoided, perhaps including diving during the peri-ovulatory period of the menstrual cycle. Furthermore, contrast PFO testing in fertile females may be most sensitive if conducted mid-cycle.
月经被描述为潜水员发生神经减压病的一个危险因素。在考虑月经与矛盾性气体栓塞的关系时，我们推测在周期依赖性激素变化与右向左分流（RLS）的表现之间可能存在联系。
40名月经周期为28天且规律的女性在月经周期的第1天和第15天接受了经颅多普勒超声检查（TCD）。脑内高强度瞬态信号（HITS）证实存在RLS。
我们发现RLS发生率为25%，与文献报道一致。在10名分流阳性女性中，有7名主要或仅在第15天检测到RLS。这种卵圆孔未闭（PFO）检出率的差异具有统计学意义（p = 0.031），表明在围排卵期RLS更多见。
我们的结果不支持月经作为神经减压病的危险因素。导致全身血管扩张的围排卵期雌激素高峰可能解释了我们的数据。应避免增加发生RLS及由此导致矛盾性栓塞风险的因素，可能包括在月经周期的围排卵期潜水。此外，对于育龄期女性，若在月经周期中期进行对比增强PFO检测，可能最为敏感。
