Cerebro-spinal decompression sickness: report of two cases

Study design: Two case reports. Objective: To describe two unusual cases of deep diving followed by cerebro-spinal decompression sickness (DCS). Setting: Midlands Centre for Spinal Injuries, England. Methods: Observation of the outcome of two different cases of cerebro-spinal DCS, who have received two different modalities of treatment. Results: The first patient's symptoms developed after he surfaced, he was treated according to the US Navy treatment table 6 . He also received steroids for almost 3 weeks. His MRI of the brain and spinal cord, which was performed within 24 h of injury did not show any abnormality, while a repeat MRI 3 weeks later revealed abnormal signals in the brain and spinal cord. The second patient's symptoms started before he surfaced, he was treated with Comex 30 treatment table for 14 days and received no steroids, his MRI was performed 3 days after the injury showed high signals in the brain and spinal cord. Conclusion: Both divers developed cerebro-spinal dysfunction. They had encephalopathy (manifested by loss of consciousness), which indicates bilateral cerebral dysfunction. DCS can occur even when dives are conducted according to the procedures described by the US Navy. The use of high-dose steroids has not been formally tested in DCS; their use is controversial.