Leschka S C, Schumacher M
Abteilung für Neuroradiologie, Neurozentrum, Universitätsklinikum Freiburg.
Dtsch Med Wochenschr. 2012 Mar;137(9):425-8. doi: 10.1055/s-0031-1298952. Epub 2012 Feb 21.
A 33-year-old experienced female diver complained of headache and chest pain when emerging after a dive. When she was rescued, tetraplegia, clouding of consciousness and aphasia were stated. The first measures consisted in the securing of the vital functions and the immediate administration of pure oxygen. Then she was transferred to the next hospital. During the 7-hour-transfer the sensory disturbances and the palsy of the left body side improved.
Computed tomography with contrast agent revealed a subcortical parieto-occipital brain edema in the left hemisphere without midline shift. Additionally a magnetic resonance imaging (MRI) after the second pressure chamber treatment showed a smaller brain edema on the right side.
DIAGNOSIS, THERAPY AND COURSE: The findings supported the diagnosis of decompression sickness type II. On the evening after the diving accident a generalised seizure occurred. Due to repeated cerebral seizures 20 mg of diazepam were administered. This was followed by a transport to the next health facility with a pressure chamber. After two pressure chamber treatments within 24 hours the clinical symptoms disappeared, the neurological examination was unremarkable and MRI had returned to normal.
An acute decompression sickness is diagnosed purely clinically. In case of even the slightest suspicion the patient should be transported to a health facility with a pressure chamber as quickly as possible because this significantly improves prognosis. Up to that point, the administration of pure oxygen is indicated. Imaging methods realised within the first hours/days are valuable for securing the diagnosis. Follow-up MRI-scans serve to reflect the course of the disease.
一名33岁经验丰富的女性潜水员在潜水后出水时抱怨头痛和胸痛。获救时，她出现四肢瘫痪、意识模糊和失语症状。首先采取的措施是维持生命功能并立即给予纯氧。随后她被转至下一家医院。在7小时的转运过程中，左侧身体的感觉障碍和麻痹有所改善。
增强计算机断层扫描显示左半球皮质下顶枕部脑水肿，无中线移位。此外，第二次高压舱治疗后的磁共振成像（MRI）显示右侧脑水肿较小。
诊断、治疗及病程：这些检查结果支持Ⅱ型减压病的诊断。潜水事故当晚发生了全身性癫痫发作。因反复出现癫痫发作，给予20毫克地西泮。随后将患者转运至下一家设有高压舱的医疗机构。在24小时内进行两次高压舱治疗后，临床症状消失，神经系统检查无异常，MRI也恢复正常。
急性减压病完全依靠临床诊断。一旦有哪怕最轻微的怀疑，应尽快将患者转运至设有高压舱的医疗机构，因为这能显著改善预后。在此之前，应给予纯氧。在最初数小时/数天内进行的影像学检查对确诊很有价值。后续的MRI扫描有助于反映疾病的病程。
