Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc · 2026
Case of Broca's Aphasia as an expression of cerebral decompression sickness with advanced non-invasive monitoring during HBO₂ treatment.
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Schmitz Gerald, Aguero Sharon, Gabert Luis Carlos Huertas
Аннотация
INTRODUCTION: We present a case of severe CNS decompression sickness (DCS) that included Broca's aphasia in a recreational diver, offering insights into the application of advanced non-invasive monitoring during hyperbaric oxygen treatment (HBO₂).
CASE REPORT: This 64-year-old male diver experienced the onset of expressive aphasia, vertigo, and right-sided hemiparesis about 30-120 minutes after surfacing following a rapid ascent after a deep dive.
DISCUSSION: Initial monitoring with bispectral index (BIS) and density spectral array (DSA) revealed significant asymmetry between cerebral hemispheres, particularly in spectral edge frequency (SEF) values, with the left hemisphere showing a marked reduction during air breaks at HBO₂ pressures. This pattern resolved progressively over three HBO₂ sessions, with full clinical recovery after four sessions, coinciding with the resolution of this DSA hemispheric asymmetry. The case indirectly supports the theoretical roles of microparticles and endothelial dysfunction in contributing to cerebral hypoperfusion in DCS, beyond the conventional focus on gas bubbles, as reflected in the clinical findings and the clinical gradient. This novel application of BIS-DSA in hyperbaric medicine offers promising potential for real-time monitoring of cerebral involvement. It could enhance patient outcomes by guiding individualized treatment in neurologically compromised DCS cases.
CASE REPORT: This 64-year-old male diver experienced the onset of expressive aphasia, vertigo, and right-sided hemiparesis about 30-120 minutes after surfacing following a rapid ascent after a deep dive.
DISCUSSION: Initial monitoring with bispectral index (BIS) and density spectral array (DSA) revealed significant asymmetry between cerebral hemispheres, particularly in spectral edge frequency (SEF) values, with the left hemisphere showing a marked reduction during air breaks at HBO₂ pressures. This pattern resolved progressively over three HBO₂ sessions, with full clinical recovery after four sessions, coinciding with the resolution of this DSA hemispheric asymmetry. The case indirectly supports the theoretical roles of microparticles and endothelial dysfunction in contributing to cerebral hypoperfusion in DCS, beyond the conventional focus on gas bubbles, as reflected in the clinical findings and the clinical gradient. This novel application of BIS-DSA in hyperbaric medicine offers promising potential for real-time monitoring of cerebral involvement. It could enhance patient outcomes by guiding individualized treatment in neurologically compromised DCS cases.