Budal Ole H, Risberg Jan, Troland Kari, Moen Gunnar, Nordahl Stein Helge Glad, Vaagboe Guro, Grønning Marit
Department of Occupational Medicine/Hyperbaric Medical Unit, Haukeland University Hospital, Bergen, Norway.
Undersea Hyperb Med. 2011 Jan-Feb;38(1):73-9.
Pneumocephalus is a recognized complication from head and facial traumas, sinus surgery and as a complication from otitis media acuta. Only a few cases of pneumocephalus related to diving have been reported.
We report an occupational diver who suffered spontaneous subarachnoidal pneumocephalus related to a dive to 20 meters. At a depth of 17 msw he suffered from sudden onset of headache, dizziness, nausea and feeling of disorientation. He had no recognized risk factors such as documented facial fractures, rapid ascent or blocked sinuses. CT showed air in the subarachnoidal space. Otoneurological tests revealed pathological smooth pursuit tracking eye movements and substantial imbalance indicating a central neurological injury. CT and MRI showed a bony defect in the sphenoid sinus covered only by arachnoidea. This was probably the communicative fistula for the entrance of air. On follow-up examination one year later he still had central nervous symptoms and signs, as well as symptoms of post-traumatic stress disorder (PTSD.) He was not able to do any work and was declared unfit for further diving. We chose not to treat him with hyperbaric oxygen (HBO2) in the acute state because we thought HBO2 might have increased the amount of intracranial air.
Pneumocephalus is a rare, but serious complication of diving. The condition should be suspected in a diver with increasing headache or other central nervous disturbancies during ascent. The treatment of pneumocephalus in divers is a matter of debate.
气颅是头部和面部创伤、鼻窦手术以及急性中耳炎的一种公认并发症。仅有少数与潜水相关的气颅病例被报道。
我们报告一例职业潜水员，他在潜水至20米深度时发生自发性蛛网膜下腔气颅。在水下17米时，他突然出现头痛、头晕、恶心和定向障碍感。他没有如记录在案的面部骨折、快速上升或鼻窦堵塞等公认的危险因素。CT显示蛛网膜下腔有气体。耳神经学检查显示异常的平稳跟踪眼球运动和明显的平衡失调，提示中枢神经系统损伤。CT和MRI显示蝶窦有一骨质缺损，仅由蛛网膜覆盖。这可能是空气进入的交通性瘘管。一年后的随访检查中，他仍有中枢神经症状和体征，以及创伤后应激障碍（PTSD）症状。他无法工作，被宣布不适宜进一步潜水。在急性期我们未选择用高压氧（HBO2）治疗他，因为我们认为HBO2可能会增加颅内气体量。
气颅是潜水的一种罕见但严重的并发症。对于在上升过程中出现头痛加剧或其他中枢神经紊乱的潜水员应怀疑此病。潜水员气颅的治疗存在争议。
