Delayed blood-brain barrier disruption after shallow-water diving demonstrated by magnetic resonance imaging

A 22-year-old diver presented to our emergency room complaining of headaches and left side numbness three days after diving to a depth of 6 metres for 25 minutes. On examination, he had left-sided hypaesthesia, and a post-contrast FLAIR brain MRI sequence revealed significant diffuse meningeal enhancement, indicating blood-brain-barrier (BBB) disruption. The patient was treated with hyperbaric oxygen; the initial four sessions resulted in only partial symptom improvement correlating with partial improvement in the MRI findings. Ten additional hyperbaric treatments resulted in complete resolution of the symptoms and normalization of MRI findings. The main aim of this case report is to present a probable, atypical, delayed-onset case of shallow-water decompression sickness culminating in significant BBB damage, which was demonstrated by special MRI techniques.