Aspects of neurological decompression illness: a view from Bethesda.

A minority of divers with neurological decompression illness (DCI) fail to improve with recompression treatment. This is particularly seen in cases where features of severe spinal cord injury develop soon after surfacing. Haemorrhage into the spinal cord is implicated in the pathogenesis of these cases, and evidence is presented that supports the view that the bleeding coincides with shrinkage of autochthonous bubbles. The role of hyperbaric oxygen therapy in the treatment of spinal cord DCI is discussed with reference to possible benefit in ischaemia-reperfusion (I-R) injury. Similarities and differences between the tissue injury of dysbaric and conventional spinal cord injury are outlined. The implications of advances in drug therapy for conventional spinal cord trauma are considered in the context of their potential application to treat neurological DCI.