Spinal cord degeneration associated with type II decompression sickness: case report

Area of Science:

• Neuropathology
• Diving Medicine
• Spinal Cord Injury

Background:

• Decompression sickness (DCS) can cause neurological injury.
• Type II DCS involves spinal cord damage, often termed a spinal 'bend'.
• Understanding the precise pathological mechanisms is crucial for patient outcomes.

Observation:

• A 50-year-old male amateur diver experienced Type II DCS.
• He survived for 4 years with paraplegia.
• Necropsy revealed spinal cord pathology.

Findings:

• Multiple small and medium-sized infarcts were identified in the spinal cord.
• These infarcts affected the centripetal arterial supply to the cord.
• Upward Wallerian degeneration in posterior columns and downward degeneration in corticospinal tracts were observed.
• A rim of subpial fibers in posterior and lateral columns was preserved.
• The grey matter and adjacent white matter, supplied by centrifugal arteries, remained unaffected.

Implications:

• This case highlights the specific vascular territories affected in spinal DCS.
• The findings explain the pattern of neurological deficits and degeneration.
• Preservation of grey matter suggests differential vulnerability based on arterial supply.