Delayed cerebral edema complicating cerebral arterial gas embolism: case histories

A disquieting and rarely described feature of the treatment of arterial gas embolism (AGE) is the high incidence of relapse following good to excellent initial responses to recompression therapy. This paper includes a discussion of the issues involved in the etiology and clinical approach to the specific problem of relapse and relates experience from selected clinical cases to a modified therapeutic approach that has been introduced into Royal Navy diving and submarine medicine practice. It illustrates how and why current treatment procedures have been expressly designed to minimize the incidence of relapse and to modify favorably the pathophysiological responses (particularly vasogenic cerebral edema) associated with cerebral AGE.