Decompression Sickness Myelopathy: Case Report and Acute Management Review for the Neurologist

Decompression sickness (DCS) is an uncommon but important cause of acute myelopathy that neurologists should recognize in the emergency setting. We report a 43-year-old experienced technical diver who developed acute sensory loss with a thoracic sensory level, gait dysfunction, upper motor neuron signs, and urinary retention after rapid ascent from approximately 90 feet below sea level. Thoracic spine MRI demonstrated longitudinal, posterior-predominant T2/STIR hyperintensity from T3 to T10-11 without pathologic enhancement, supporting spinal cord DCS. He received prompt hyperbaric oxygen therapy using U.S. Navy Treatment Table 6, along with 100% oxygen, horizontal positioning, and intravenous fluid resuscitation, followed by additional hyperbaric treatments for persistent sensory and autonomic symptoms. He improved rapidly, regained independent ambulation, and later returned to high-level physical activity, although intermittent sensory symptoms persisted during follow-up. This case illustrates the clinical presentation of spinal cord DCS and emphasizes the importance of early hyperbaric oxygen therapy alongside consensus-supported measures for oxygenation, intravascular volume repletion, thermal protection, and safe positioning. The independent effects of these supportive measures on neurologic recovery remain uncertain. Evidence for additional pharmacologic adjuncts, including NSAIDs and corticosteroids, is limited, and cerebrospinal fluid drainage remains unproven in DCS.