The Effect of HBOT Tailing Treatment on Neurological Residual and PSCT Brain Images in Type II (Cerebral) DCI/CAGE.
PG Harch, KW Van Meter, SF Gottlieb, P Staab. JoEllen Smith Hyperbaric Medicine Unit, New Orleans, LA 70131.
Background: No guidelines exist for HBOT tailing treatment of residual neurological injury and no studies document their effect on SPECT brain images and neurological condition in Type II/CAGE DCI as we report herein.
Methods: All divers with Type II (Cerebral) DCI or CAGE who underwent HMPAO (11) or IMP (2) SPECT brain imaging during and after hyperbaric treatment were included. 7 of 13 divers also had scans immediately after a 1.5 or 1.75/90 minute test HBO exposure. Scanning was performed on a Picker Prism 3000 (HMPAO) or ADAC single-head system (IMP). Primary treatment: 1 or more standard US Navy recompression procedures (USN6, 6A, 6A1M, 5, sat), followed by tailing HBOT, 1.5-2.0 ATA/60-120 minutes until clinical plateau. Two discontinued treatment prematurely.
Results: Tailing HBOT was continuous with primary treatment in 9 divers and delayed 4, 13, 72 and 86 d in others. 2 of 13 divers had additional tailing HBOT 129 and 307d post first set of tailings. Average number of tailings: 14 (for primary symptom improvement), 34 (symptom plateau), 60 (total). 13 of 13 divers had abnormal SOECT scans during treatment, average 4d and 8 HBOT post primary tailing treatment began; neurologic symptoms improved at the end of HBOT and these correlated with an improvement in all scans (avg. 61 d post end of treatment). 6 of 7 post dive test scans were improved and predicted final scan and clinical condition. Outcomes were good to excellent in all cases.
Conclusion: Prolonged (4-6 weeks) HBOT tailings at low pressure, 1.5-2.0 atm abs, are effective treatment for neurological residual of Type II (cerebral) DCI/CAGE, even when delayed months. SPECT brain imaging reflects neurological condition during and post treatment and may be used to predict the possibility of improvement when performed immediately after a test HBOT.
