Magnetic Resonance Imaging in Spinal Cord Decompression Sickness

Gianvincenzo Sparacia, MD, Massimo Galia, MD, Giuseppe Brancatelli, MD, and Benedetta Sparacia, MD, Palermo, Italy

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Abstract and Introduction

During decompression, the body attempts to eliminate the excess inert gas by perfusion and diffusion. When it is unsuccessful, there is a separation from solution in the tissues of inert gas and the formation of bubbles in veins, tissues, and, rarely, arteries. If the quantity of bubbles exceeds the capacity of tissues to bear this load, the result is decompression sickness. Scuba divers generally use compressed air as the breathing mixture, and in their case the inert gas that is liberated during decompression is nitrogen. MRI, because of its high sensitivity in detection of spinal cord pathologic changes and its advantages of direct multiplanar imaging capability, has proven to be reliable in the early detection of spinal cord lesions that occur in scuba diving accidents, in structuring a prompt hyperbaric treatment, and also in the follow-up during therapeutic hyperbaric recompression.

Decompression sickness (DCS) is a clinical syndrome caused by alterations in environmental pressure, which result in the liberation into tissue or blood of inert gas bubbles previously maintained within the tissues in a soluble state.[1,2,3] Sport divers generally use compressed air as the breathing mixture, and in their case, the inert gas that is liberated during decompression is nitrogen.

Hyperbaric oxygen therapy provided in specially designed pressure chambers is currently the treatment of choice for DCS. Until the patient reaches a hyperbaric medical facility, proper hydration and the administration of oxygen at the highest possible concentration must be provided. We present the magnetic resonance imaging (MRI) findings of pathologic changes of the spinal cord in DCS, previously undetectable by other neuroimaging modalities.

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