AD 2016 Q3
Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.
Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.
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RESEARCH, EDUCATION & MEDICINE<br />
FROM THE MEDICAL LINE<br />
STEPHEN FRINK<br />
Facial Baroparesis<br />
DAN MEDICS AND RESEARCHERS ANSWER<br />
YOUR QUESTIONS ABOUT DIVE MEDICINE.<br />
Q:<br />
I<br />
droop and cognitive problems. It makes<br />
understand that arterial gas embolism<br />
(AGE) can manifest like a stroke, with facial<br />
sense that bubbles in the brain could cause such<br />
serious symptoms, but I have also heard about<br />
facial droop occurring with much less severe dive<br />
injuries. How could this happen?<br />
A: Island, Indonesia. The diver was doing several<br />
This phenomenon is illustrated by a recent case<br />
involving a 46-year-old male diving in Ambon<br />
days of repetitive diving using 32 percent enriched<br />
air nitrox. Recent diving days included 50- to 90-foot<br />
dives that lasted 60 to 90 minutes. He typically did two<br />
or three dives per day. On his fourth day of diving, he<br />
did a dive to 93 feet for a total dive time of 51 minutes<br />
and then, following a five-hour surface interval, he did<br />
a second dive to 50 feet for 41 minutes.<br />
Ten minutes after surfacing from this second dive,<br />
he experienced left facial weakness and a contracture<br />
of his left hand. He also described his tongue as feeling<br />
“numb” and “thick.” Upon further questioning the<br />
diver stated that he experienced a significant reverse<br />
ear squeeze earlier that day. He was immediately<br />
administered oxygen via a mask on the dive boat.<br />
By chance, a neurologist was present on the dive<br />
boat and performed a medical evaluation. The<br />
physician found that the left facial muscle weakness<br />
involved the forehead as well as the lower face. All of<br />
the diver’s symptoms except for the “thick” tongue<br />
sensation resolved within 30 minutes of breathing<br />
100 percent oxygen. Because of his symptoms and<br />
multiday diving history, the dive staff were concerned<br />
about decompression illness (DCI) and recommended<br />
evaluation by a physician trained in dive medicine.<br />
The differential diagnosis in this case encompasses<br />
many nondiving- and diving-related diseases. Given the<br />
multiday diving history and rapid onset of symptoms,<br />
it is certainly prudent to consider DCI. The anatomical<br />
distribution and type of symptoms are not typical for<br />
decompression sickness (DCS), however, and without a<br />
rapid or uncontrolled ascent, AGE is not likely. Possible<br />
non-diving-related maladies include a cerebral vascular<br />
accident (CVA) and a transient ischemic attack (TIA),<br />
commonly referred to as a stroke and mini-stroke,<br />
respectively. These conditions, however, would likely<br />
56 | SUMMER <strong>2016</strong>
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