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Acute massive posterior stroke with tonsillar herniation in a scuba diver
Gufran Algaly1, Sara M I Ahmed1, Amro Abdelrahman2
1Emergency Department, Hamad Medical Corporation, Doha, Qatar.
Oxford Medical Case Reports
|August 28, 2024
Summary
A scuba diver experienced stroke symptoms like drowsiness and headache. Prompt neurosurgical intervention for posterior circulation infarction and hydrocephalus led to a full recovery.
Area of Science:
- Neurology
- Neurosurgery
- Diving Medicine
Background:
- Scuba diving can pose risks, including neurological complications.
- Posterior circulation stroke is a critical condition requiring urgent management.
Observation:
- A female scuba diver presented with drowsiness, dizziness, and headache post-dive.
- Initial assessment revealed normal vital signs but a CT scan showed severe posterior circulation infarction with mass effect, hydrocephalus, and cerebellar tonsillar herniation.
Findings:
- Extensive workup for stroke etiology was negative, except for an incidental patent foramen ovale (PFO).
- Neurosurgical intervention, including extraventricular drain (EVD) insertion and posterior fossa decompression, was performed.
- Postoperatively, the patient showed rapid neurological improvement and resolution of mass effect.
Implications:
- This case highlights the importance of considering diving-related neurological emergencies.
- Early recognition and multidisciplinary management are crucial for favorable outcomes in posterior circulation stroke.
- Patent foramen ovale may be a contributing factor in paradoxical embolism during diving, warranting further investigation.
