J Korean Soc Emerg Med.  2017 Aug;28(4):387-390. 10.0000/jksem.2017.28.4.387.

3.0 T MRI Findings in Cerebral Decompression Sickness: A Case Report

• Kang HD
• Oh SH
• Jung SK

• KMID: 2393983
• DOI: http://doi.org/10.0000/jksem.2017.28.4.387

Abstract

We presented a patient with cerebral decompression sickness, who showed predominant vasogenic edema on a 3.0 Tesla (3T) magnetic resonance imaging (MRI) findings, including diffusion-weighted image (DWI) and apparent diffusion coefficient (ADC) mapping. Within minutes of surfacing, he developed paresis of the right lower limb. During transport, he began shivering, followed by severe spasm that eventually progressed to a tonic-clonic seizure. Emergent hyperbaric oxygen therapy (HBOT) was performed with U.S. Navy treatment table 6A after a treatment of seizure activity. Brain MRI was performed after hyperbaric oxygen therapy to detect any cerebral lesions, which showed subcortical hyperintensity signal changes in the left fronto-parietal region on the ADC map. Overlying cortical hyperintensity on DWI sequences and cortical hypointensity on the ADC map were simultaneously observed. Moreover, these findings disappeared in a followup MRI with complete resolution of symptoms. These findings indicate that vasogenic edema can cause cerebral decompression sickness (DCS) and that 3T MRI with DWI and ADC mapping may be useful for diagnosing cerebral DCS. In addition, these findings suggest that DW-MRI may also be useful in predicting the prognosis of cerebral DCS.

Keyword

Decompression sickness; Diffusion magnetic resonance imaging; Brain edema

MeSH Terms

Brain
Brain Edema
Decompression Sickness*
Decompression*
Diffusion
Diffusion Magnetic Resonance Imaging
Edema
Follow-Up Studies
Humans
Hyperbaric Oxygenation
Lower Extremity
Magnetic Resonance Imaging*
Paresis
Prognosis
Seizures
Shivering
Spasm