Cervicocranial artery dissection and scuba diving: Is there a link or is it serendipity?

Abstract

Numerous reports have documented cervicocranial artery dissection (CCAD) associated with scuba diving. The question remains as to whether there are risk factors unique to scuba diving related to the occurrence of CCAD. This article aims to perform an examination of the reported cases to demonstrate any commonality among the injured divers and association with known risk factors for CCAD. A PubMed search was performed utilizing the key words: carotid artery dissection, dissection, arterial dissection, cranial artery dissection, scuba, diving, scuba diving. Articles including reports, reviews, trials, case series, and letters were considered. Each report was critically dissected for information specific to the dive itself and the diver and analyzed for similarities and consistency with known risks. Twelve (12) reports of CCAD associated with scuba diving were identified. Activities involved with scuba diving appear to be consistent with CCAD risk factors. It is unclear if hyperbaric stress and physiological changes during a dive present specific risk. Trauma - e.g., environmental protection and activities associated with diving - was identified as a common risk factor in all cases. Ten (10) cases involved arteries at anatomic sites commonly associated with dissections. Seven divers documented to have dive profiles suspicious of decompression sickness were identified. There appears to be a correlation with minor traumas that occur with diving and CCAD. The inconsistency of the dive-related specific information reported makes it impossible for investigation of hyperbaric stress-related risk factors for CCAD to be analyzed.