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Low Pressure HBOT and SPECT Scan in Type II Decompression Sickness

We describe a prospective case study of a sport SCUBA diver with Type II Decompression Sickness (brain injury) in which HMPAO SPECT Scan brain imaging with oxygen intervention was used in the identification of potentially recoverable brain tissue which subsequently responded to low pressure Hyperbaric Oxygen Therapy as demonstrated by improvement in neurological functions and seen in SPECT Scan brain images.

Hyperbaric Oxygen Therapy for Decompression Illness in Divers


Diana Marie Barratt, MD, MPH, Paul C. Harch MD, and Keith Van Meter, MD

(THE NEUROLOGIST 8:186-202, 2002)

BACKGROUND- Neurologists may be consulted to diagnose and treat the severe neurologic injuries that can occur in divers with decompression illness (DCI).

REVIEW SUMMARY- Subclinical bubbles form during normal diving activity. DCI, a diffuse and multifocal process, results when bubbles cause symptoms by exerting mass effect in tissues, or obstructing venous or arterial flow. The lower thoracic spinal cord is a commonly affected area of the central nervous system. The most commonly described form of brain DCI is cerebral arterial gas embolism with middle cerebral artery or vertebrobasilar distribution involvement. Bubbles exert secondary damage to the vascular endothelium, causing activation of numerous biochemical cascades.

CONCLUSIONS- Divers can develop DCI on very short dives or in shallow water, even when adhering to protocols. DCI should be strongly considered when divers experience pain after diving. Any neurologic symptoms after a dive are abnormal and should be attributed to DCI. Even doubtful cases should be treated immediately with hyperbaric oxygen (HBOT), after a chest x-ray to rule out pneumothorax. The Divers Alert Network should be contacted for emergency consultation. Delay to treatment can worsen outcome; however, the overwhelming majority of divers respond to HBOT even days to weeks after injury. Although DCI is a clinical diagnosis, magnetic resonance imaging, somatosensory evoked potentials, single-photon emission tomography, and neuropsychologic testing help to document disease and monitor response to therapy. Divers should be treated with HBOT until they reach a clinical plateau. Complete relief of symptoms occurs in 50% to 70% of divers; 30% have partial relief.

Decompression illness (DCI) is a systemic disease that can result in severe neurologic consequences. Neurologists may be consulted to assist in the diagnosis and management of injured divers. This article reviews the English literature on the diagnosis and treatment of DCI, with an emphasis on United States practice patterns.

From the Department of Neurology, Louisiana State University in New Orleans, New Orleans, Louisiana and the Department of Medicine, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University in New Orleans, New Orleans, Louisiana.

SPECT: Diagnostic Imaging that is Best for Hyperbaric Oxygen Therapy (HBOT)

 Diagnostic Imaging and Hyperbaric Oxygen Therapy

Drs. P.G. Harch, R.A. Neubauer, J.M. Uszler, and P.B. James

The authors of the Appendix to K. K. Jain's Textbook of Hyperberic Medicine


What is Diagnostic Imaging

Diagnostic imaging plays an important role in diagnosis of diseases of the central nervous system (CNS). It is even more important in assessing the effects of Hyperbaric Oxygen Therapy (HBOT) on hypoxic/ischemic lesions of the brain. Various techniques that are relevant to HBOT include:

  • Single Photon Emission Computerized Tomography (SPECT Scan),
  • Positron Emission Tomography (PET Scan),
  • Functional Magnetic Resonance Imaging (MRI),
  • Magnetic Resonance Spectroscopy MR spectroscopy, or (MRS)

For practical purposes, SPECT using hexamethylpropyleneamine (HMPAO) or ethyl cysteinate dimer (ECD) is the most practical and widely used diagnostic procedure in combination with Hyperbaric Oxygen Therapy. This technique is illustrated in this appendix.

Improvement Seen in Traumatic Brain Injury Treated with Low Pressure HBOT

The brain injury program is a direct outgrowth of the extensive experience of Dr. Harch treating chronically brain injured patients, the independent 22 year clinical Hyperbaric Oxygen Therapy experience of Dr. Harch's practice group (Van Meter and Associates) at the Jo Ellen Smith Medical Center Hyperbaric Medicine Unit, the published reports of Drs. Richard A Neubauer and S.F. Gottlieb, and the 27 year clinical experience with brain injury of Dr. R.A Neubauer in Florida. In the late 1980's while at the Jo Ellen Smith Hyperbaric Medicine Unit, Dr. Harch observed patients with cerebral decompression sickness and/or air embolism who responded to hyperbaric oxygen therapy long after treatment of inert gas bubbles had passed or with delayed treatment months to years after standard U.S. Navy treatments had achieved partial success. In addition, Dr. Harch observed patients with brain contusion or stroke who, months to years after their neurological injury, concomitantly experienced gratuitous neurological improvement during the course of Hyperbaric Oxygen treatment for one of the standard accepted indications.

Harch HBOT in Cerebral Palsy and Pediatric Neurology: A Scientific Perspective

This article will review the current literature and history of application of low pressure (low dosage) LPHBOT to pediatric neurology. The most rigorous study on this subject will be analyzed and its interpretation debated in terms of past and present scientific data and theoretical considerations. The major flaw in the study's conclusion is illustrated by pre and post HBOT SPECT brain imaging on two of the author's cerebral palsy patients and the author's 12-year-experiehce of HBOT treatment of Cerebral Palsy children. There is substantial scientific explanation and data to argue for reimbursement of HBOT in Cerebral Palsy.


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