Prevalence of patent foramen ovale (PFO) and MRI-lesions in mild neurological decompression sickness (type B-DCS/AGE).

BACKGROUND Neurological decompression sickness (DCS/AGE) may cover two variants with either severer and probably central nervous (Type A) or milder and sometimes doubtful neurological symptoms (Type B). The pathophysiology of the Type B-DCS/AGE might be different from the Type A-variant. In Type A-DCS/AGE a higher PFO-prevalence (patent foramen ovale) points towards an embolic origin of the Type A-symptomatology. This is not necessarily expected for the Type B-DCS/AGE if the pathophysiology here is micro-embolic or even non-embolic. METHODS 18 patients with Type B-DCS/AGE were tested against matched controls for presence and size of a PFO with echocardiography and transcranial ultrasound with echo-contrast. Prevalence and number of Type A-brain lesions were visualized by cranial MRI as possible sequelae from gas-embolic events. RESULTS PFO-prevalence in both groups, the patients with Type B-DCS/AGE (5/18) as well as the controls (7/18) was similar to published PFO-prevalences in normals without any difference between patients and controls (p = 0.725). Also the number of MRI-lesions (ACFs) was the same for Type B-DCS/AGE cases (15 ACFs in 5 patients) and controls (37 ACFs in 8 divers). CONCLUSION Indirect findings suggesting embolic brain injuries are found with similar frequency in patients with Type B-DCS/AGE and normal controls, which is in contrast to data about Type A-DCS/AGE. This is compatible with different pathophysiological mechanisms involved in the Type A- and Type B-DCS/AGE.