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Related Experiment Video

Updated: Oct 5, 2025

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

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Risk stratification of neurological decompression sickness in divers.

M Sramek, J Honek, A Tomek

    Bratislavske Lekarske Listy
    |January 23, 2022
    PubMed
    Summary

    Divers with a right-to-left shunt (RLS) have a significantly higher risk of neurological decompression sickness (DCSneuro). This risk escalates with the severity of the RLS, indicating PFO screening is crucial for diver safety.

    Keywords:
    decompression sicknessright-to-left shunt transcranial sonography.

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    Area of Science:

    • Diving Medicine
    • Cardiology
    • Neurology

    Background:

    • Patent foramen ovale (PFO) is a known risk factor for decompression sickness (DCS).
    • Limited data exists for risk stratification of divers with PFO.
    • Neurological DCS (DCSneuro) risk assessment in divers with PFO requires further investigation.

    Purpose of the Study:

    • To evaluate the risk of neurological decompression sickness (DCSneuro).
    • To assess the impact of the presence and grade of a right-to-left shunt (RLS) on DCSneuro risk.
    • To determine if transcranial Doppler (TCD) is suitable for RLS screening and risk stratification in divers.

    Main Methods:

    • Screened 640 divers for RLS using TCD between January 2006 and April 2017.
    • Graded RLS as low, medium, or high, with subgroups for Valsalva maneuver and rest.
    • Utilized survival analysis to identify risk factors for unprovoked DCS.

    Main Results:

    • A RLS was detected in 40.3% of divers.
    • Divers with RLS had a significantly higher incidence of DCSneuro (17.1%) compared to those without (1.3%).
    • DCSneuro incidence increased from 4.6% (low-grade RLS) to 57.1% (high-grade RLS at rest), with a hazard ratio of 11.806 for RLS.

    Conclusions:

    • Divers with RLS face an elevated risk of DCSneuro.
    • The risk of DCSneuro is directly correlated with the grade of RLS.
    • TCD is recommended for RLS screening and risk stratification in divers.