A case of decompression illness not responding to hyperbaric oxygen.

Area of Science:

• Diving Medicine
• Neurology
• Cardiology

Background:

• Decompression illness (DCI) necessitates considering multiple pathologies.
• A multidisciplinary team approach is crucial for complex cases.
• Atypical presentations of DCI require thorough differential diagnosis.

Observation:

• A 42-year-old male presented with neurological deficits post-scuba diving.
• Initial hyperbaric oxygen therapy was unsuccessful.
• Investigations revealed polycythaemia and a patent foramen ovale.

Findings:

• Despite typical DCI symptoms, initial treatments failed.
• MRI showed ischemic changes, but no gas embolism.
• A patent foramen ovale was identified as a potential contributing factor.
• Diagnosis of exclusion was decompression sickness.

Implications:

• Patent foramen ovale can exacerbate DCI by allowing arterial gas emboli.
• Atypical DCI presentations underscore the need for comprehensive diagnostic workups.
• This case emphasizes the importance of considering DCI even with unusual symptoms.