Association between right-to-left shunts and brain lesions in sport divers

Journal Article

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Aviation, Space, and Environmental Medicine

Aviat.Space Environ.Med.

Oct

1058

1060

LR: 20061115; JID: 7501714; 0 (Contrast Media); ppublish

United States

0095-6562; 0095-6562

PMID: 14556567

eng

Journal Article; Research Support, Non-U.S. Gov't; IM; S

Unknown(0)

14556567

BACKGROUND: Recent studies suggest that healthy sport divers may develop clinically silent brain damage, based on the association between a finding of multiple brain lesions on MRI and the presence of right-to-left shunt, a pathway for venous gas bubbles to enter the arterial system. METHODS: We performed echocontrast transcranial Doppler sonography in 42 sport divers to determine the presence of a right-to-left shunt. Cranial MRI was carried out using a 1.5 T magnet. A lesion was counted if it was hyperintense on both T2-weighted and T2-weighted fluid attenuated inversion recovery sequences. To test the hypothesis that the occurrence of postdive arterial gas emboli is related to brain lesions on MRI, we measured postdive intravascular bubbles in a subset of 15 divers 30 min after open water scuba dives. RESULTS: Echocontrast transcranial Doppler sonography revealed a right-to-left shunt in 16 of the divers (38%). Only one hyperintensive lesion of the central white matter was found and that was in a diver with no evidence of a right-to-left shunt. Postdive arterial gas emboli were detected in 3 out of 15 divers; they had a right-to-left shunt, but no pathologic findings on cranial magnetic resonance imaging. CONCLUSIONS: Our data support the theory that right-to-left shunts can serve as a pathway for venous gas bubbles into the arterial circulation. However, we could not confirm an association between brain lesions and the presence of a right-to-left shunt in sport divers.

Adult, Brain/blood supply/pathology, Brain Diseases/etiology/physiopathology, Cerebral Arteries/abnormalities, Contrast Media/administration & dosage, Decompression Sickness/etiology/physiopathology, Diving/adverse effects, Echoencephalography, Embolism, Air/physiopathology, Female, Humans, Magnetic Resonance Imaging, Male, Ultrasonography, Doppler

Gerriets,T., Tetzlaff,K., Hutzelmann,A., Liceni,T., Kopiske,G., Struck,N., Reuter,M., Kaps,M.

Department of Neurology, Justus-Liebig-University Giessen, Am Steg 20, 35390 Giessen, Germany. Tibo.Gerriets@neuro.med.uni-giessen.de

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2003