Risk of misclassification of decompression sickness

Decompression sickness (DCS) is classified on the basis of which organ system is affected, and neurological DCS is considered more severe than DCS in joints and skin with respect to response to recompression treatment and risk of long-term sequelae. Gas bubble formation interstitially in the tissues or in the circulation is considered to be the mechanism for all types of DCS. Ten patients diagnosed as having DCS in joints or skin, by doctors experienced in diving medicine, underwent clinical examination by a neurologist and had an electroencephalogram. Eight of the ten subjects had findings suggesting central nervous system deficits. The findings indicate that DCS of the central nervous system often accompanies DCS of the joints and skin, and that local skin and joint symptoms may draw attention away from cerebral symptoms. We recommend that all cases with DCS should initially be treated as neurological DCS.