Magnetic Resonance Imaging of the Spine in a Patient with Decompression Sickness

Abstract

The case of a 60-year-old male patient who was admitted to hospital because of a scuba diving accident is reported. The patient initially complained about dizziness and pain in the shoulders. The exact rate of ascent from diving was not known, however, the patient said that he had had a panic attack and went up very fast from a depth of at least 15 m. despite a rapid recompression the patient developed hypesthesia of the right upper limb 2 days later. To rule out a stroke magnetic resonance imaging (MrI) of the brain and the whole spinal column was performed.MrI examinations were carried out with a 1.5 Tesla system (siemens Magnetom espree). The imaging protocol included a diffusionweighted (dW) single-shot spin echo echoplanar sequence acquired from the anterior commissure-posterior commissure. For dW MrI, the diffusion gradients were successively and separately applied in three orthogonal directions for a total acquisition time of 97 s. Trace images were then generated and apparent diffusion coefficient (ADC) maps calculated with a dedicated software tool (syngo; siemens). These studies revealed signal alterations in the cervical spinal cord with an increased signal in diffusion and T2weighted images at the level of the fourth and fifth cervical vertebral body, affecting both grey and white matter (Fig. 1). diffusion-weighted imaging at the same level detected some bright lesions (Fig. 2), which could be correlated with signal alterations in T2-weighted sequences and the ADC maps also revealed a high signal in these regions (Fig. 3). The MrI scans of the brain did not detect any abnormalities. Because of these finding the diagnosis of spinal decompression sickness was made. After treatment in the decompression chamber with hyperbaric oxygen for 5 days the pain in the shoulders and the dizziness disappeared, however, the hypesthesia remained.