Decompression sickness

Changed by Ayla Al Kabbani, 31 May 2019

Updates to Article Attributes

Body was changed:

Show markup changes

Decompression sickness (DCS), also known as diver's disease,aeorbullosis, the bends or Caisson disease, is an uncommon diving-related decompression illness that is an acute neurological emergency typically occurring in deep sea divers.

Clinical Presentation

~~Diving-related decompression illness is classified into two main categories~~ ³:

~~arterial gas embolism secondary to pulmonary decompression barotrauma.~~
~~decompression~~Decompression sickness ~~(caisson disease), which~~ can be further clinically subdivided into:
- mild symptoms: arthralgia, skin marbling, small patchy ~~hemorrhages~~haemorrhages, and lymphatic obstruction
- serious and life-threatening symptoms: affecting the brain, spinal cord, inner ear, and/or lung

Pathology

Nitrogen gas bubbles can cause neurovascular infarction of the brain and spinal cord leading to neurological deficit. There are various theories to explain this, which hypothesise between arterial occlusion, venous infarction and cellular nitrogen toxicity.

Location

The white matter tracts of the spinal cord and brain are predominantly affected due to their high myelin content ³. Cord lesions are more common than brain lesions. In the spinal cord, there is a predilection for the thoracic cord segments to be affected, thought to be secondary to more nitrogen accumulating in the lateral and posterior columns where there is higher fat content and also the relatively low blood flow compared to the cervical and lumbar segments.

Complications

Radiographic features

MRI

Radiological changes are seen in early stages in MRI, but have very low specificity. The affected white matter may show ischaemic lesions or the bubbles themselves. There may also be an accumulation of nitrogen bubbles in marrow fat.

Normal MRI of the cord does not rule out the diagnosis ³. If there are MRI findings, these tend to normalise after a few weeks.

Treatment and prognosis

hyperbaric oxygen ~~therapy~~on site and during transportation followed by treatment in a recompression chamber

The quicker treatment begins, the higher the chance of successful recovery.

History and etymology

A caisson is a watertight container used in underwater construction work.

The bends refers to the joint pain associated with the disease

-<p><strong>Caisson disease</strong> is an uncommon diving-related decompression illness that is an acute neurological emergency typically occurring in deep sea divers. </p><p>Diving-related decompression illness is classified into two main categories <sup>3</sup>:</p><ol>
~~-<li>arterial gas embolism secondary to pulmonary decompression barotrauma.</li>~~
~~-<li>decompression sickness (caisson disease), which can be further clinically subdivided into:<ul>~~
~~-<li>mild symptoms: arthralgia, skin marbling, small patchy hemorrhages, and lymphatic obstruction</li>~~
+<p><strong>Decompression sickness (DCS), </strong>also known as <strong>diver's disease,</strong> <strong>aeorbullosis</strong>, <strong>the bends </strong>or <strong>Caisson disease,</strong> is an uncommon diving-related decompression illness that is an acute neurological emergency typically occurring in deep sea divers. </p><h4>Clinical Presentation</h4><p>Decompression sickness can be further clinically subdivided into:</p><ul>
+<li>mild symptoms: arthralgia, skin marbling, small patchy haemorrhages, and lymphatic obstruction</li>
~~-</ul>~~
~~-</li>~~
-</ol><h4>Pathology</h4><p>Nitrogen gas bubbles can cause neurovascular infarction of the brain and spinal cord leading to neurological deficit. There are various theories to explain this, which hypothesise between arterial occlusion, venous infarction and cellular nitrogen toxicity.</p><h5>Location</h5><p>The white matter tracts of the spinal cord and brain are predominantly affected due to their high myelin content <sup>3</sup>. Cord lesions are more common than brain lesions. In the spinal cord, there is a predilection for the thoracic cord segments to be affected, thought to be secondary to more nitrogen accumulating in the lateral and posterior columns where there is higher fat content and also the relatively low blood flow compared to the cervical and lumbar segments.</p><h5>Complications</h5><ul>
+</ul><h4>Pathology</h4><p>Nitrogen gas bubbles can cause neurovascular infarction of the brain and spinal cord leading to neurological deficit. There are various theories to explain this, which hypothesise between arterial occlusion, venous infarction and cellular nitrogen toxicity.</p><h5>Location</h5><p>The white matter tracts of the spinal cord and brain are predominantly affected due to their high myelin content <sup>3</sup>. Cord lesions are more common than brain lesions. In the spinal cord, there is a predilection for the thoracic cord segments to be affected, thought to be secondary to more nitrogen accumulating in the lateral and posterior columns where there is higher fat content and also the relatively low blood flow compared to the cervical and lumbar segments.</p><h5>Complications</h5><ul>
-</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Radiological changes are seen in early stages in MRI, but have very low specificity. The affected white matter may show ischaemic lesions or the bubbles themselves. There may also be an accumulation of nitrogen bubbles in marrow fat.</p><p>Normal MRI of the cord does not rule out the diagnosis <sup>3</sup>. If there are MRI findings, these tend to normalise after a few weeks.</p><h4>Treatment and prognosis</h4><ul><li>hyperbaric oxygen therapy</li></ul><h4>History and etymology</h4><p>A <strong>caisson</strong> is a watertight container used in underwater construction work.</p>
+</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Radiological changes are seen in early stages in MRI, but have very low specificity. The affected white matter may show ischaemic lesions or the bubbles themselves. There may also be an accumulation of nitrogen bubbles in marrow fat.</p><p>Normal MRI of the cord does not rule out the diagnosis <sup>3</sup>. If there are MRI findings, these tend to normalise after a few weeks.</p><h4>Treatment and prognosis</h4><ul><li>hyperbaric oxygen on site and during transportation followed by treatment in a recompression chamber</li></ul><p>The quicker treatment begins, the higher the chance of successful recovery. </p><h4>History and etymology</h4><p>A <strong>caisson</strong> is a watertight container used in underwater construction work.</p><p>The <strong>bends</strong> refers to the joint pain associated with the disease</p>