Memorial Care Long Medical Center, Hyperbaric Medicine Program, Long Beach, California U.S.
Duke University, Department of Anesthesiology, Division of Hyperbaric Medicine and Environmental Physiology, Durham, North Carolina U.S.
Undersea Hyperb Med. 2022 Second Quarter;49(2):563-568.
This case report describes an initially overlooked Type II decompression sickness (DCS) occurrence that was confused with a cerebral vascular accident in a patient with chronic atrial fibrillation (AF). The purpose of this case report is to reinforce the maxim that DCS needs to be suspected anytime a scuba diver experiences signs or symptoms compatible with DCS after completing a scuba dive.
A 71-year-old scuba diver with a history of AF and who was taking warfarin made four dives, all with maximum depths less than 60 fsw (20 msw) over a 10-hour interval. Shoulder pain developed before entering the water on the fourth dive and was worse after exiting from the fourth dive. Twenty minutes later the diver collapsed while standing and was unable to make a grip using his left hand. A literature review failed to locate any case reports of divers with AF presenting with strokelike symptoms only to find the cause was Type II DCS..
Initially the patient's findings were reviewed with a diving medicine team. The recommendation was for the patient to be managed for a stroke. The patient was transferred to a hospital for a computed tomography scan, but no recommendation was made for a hyperbaric oxygen recompression treatment. The scan showed no brain bleed or infarct. The attending neurologist (not diving medicine-trained) was concerned that the patient's findings were diving-related and arranged for transferring the patient to a hyperbaric medicine facility 25 hours later. With hyperbaric oxygen (HBO2) therapy the patient's symptoms remitted over several weeks.
The presence of symptoms attributed to a stroke immediately after a scuba dive should not deter a trial of HBO2 therapy. The delay in starting HBO2 therapy is concerning and perhaps the reason recovery was delayed and the need for repetitive HBO2 therapies.
本病例报告描述了一名慢性心房颤动（AF）患者在潜水后出现最初被忽视的 II 型减压病（DCS），并与脑血管意外相混淆。本病例报告的目的是强调，任何潜水员在完成潜水后出现与 DCS 相符的体征或症状时，都应怀疑发生 DCS。
一名 71 岁潜水员，有 AF 病史，正在服用华法林，在 10 小时内进行了 4 次潜水，最大深度均小于 60 英尺（20 米）。第四次潜水前入水时出现肩部疼痛，出水后疼痛加剧。20 分钟后，潜水员站着时突然晕倒，左手无法紧握。文献复习未发现任何 AF 潜水员仅出现类似中风症状的病例报告，结果发现病因是 II 型 DCS。
最初，潜水医学团队对患者的检查结果进行了评估。建议对患者进行中风治疗。患者被转至医院进行计算机断层扫描，但未建议进行高压氧复压治疗。扫描显示无脑出血或梗塞。主治神经科医生（非潜水医学培训）认为患者的症状与潜水有关，并在 25 小时后安排将患者转至高压医学设施。接受高压氧（HBO2）治疗后，患者的症状在数周内缓解。
潜水后立即出现与中风相关的症状不应阻止高压氧治疗的尝试。延迟开始高压氧治疗令人担忧，可能是导致恢复延迟和需要重复高压氧治疗的原因。
