Dr Kasner discusses the results of Gore REDUCE trial for closure of PFO after cryptogenic (unknown cause) stroke. Excellent results that should change the way PFO’s are treated in the stroke population in patients under 60 years of age.
This statistic was presented by Cardiologist Dr Peter Wilmhurst at the South Pacific Underwater Medicine Society (SPUMS) and summarised in this blog on the Diver Alert Network (DAN).
To read the full article click here
In another article on the DAN website the author discusses the interesting findings that skin mottling after diving may be the result of brain lesions caused by gas bubbles.
So it appears that skin bends should be taken seriously and that screening for a PFO needs to be seriously considered.
In a recently published paper, Kemper and colleagues1 present a novel hypothesis that links skin changes to overt or subclinical brain changes caused by cerebral arterial gas embolism (AGE). The research team from the Netherlands experimentally studied AGE in anesthetized pigs, with a focus on the effects of AGE on brain functions.2 However, they noticed that within minutes of injecting gas bubbles into cerebral circulation, a mottling appeared on the animal’s skin that resembled marbled skin characteristic of DCS in humans. They hypothesized that the brain injury resulting from the injection of gas bubbles led to a release of neuropeptides by sensory nerves in the skin, which initiated an inflammatory response and the appearance of skin mottling.
DAN injury data analysis as presented in various editions of the DAN Annual Report indicate that at least 20 percent of divers with skin DCS also have neurological symptoms that they may not be aware of but were discovered at a clinical examination. The hypothesis presented here suggests strengthening the current recommendations so that divers with skin mottling after a dive should receive a neurological evaluation. Even more, the repeated episodes of skin changes, while in itself may seem innocuous, should be taken seriously as a possible indicator of subclinical brain injury, and the diver’s diving practice should be reviewed and safety measures elevated.
The following flowchart is for divers that have had a documented Decompression Illness (DCI) event.
For the full article and for other interesting information on diving and decompression illness click the link below.