Symptoms of severe DCS include any neurologic sign or symptom consistent with injury or dysfunction of the CNS including vertigo, HEADACHE, disorientation, SLURRED SPEECH, incoordination; pulmonary symptoms (CHOKES) including chest pain, cough, and SOB; and circulatory collapse. Since there are no pathognomonic signs or symptoms or definitive laboratory tests, diagnosis depends on a high index of suspicion and a very careful history for recent credible exposure. Neurologic DCS presents in one of two forms: a peripheral form and a central nervous system form. The central nervous system DCS includes spinal cord DCS and cerebral DCS. The peripheral form often consists of paresthesias in upper or lower limbs (commonly in the same limb affected with MUSCULOSKELETAL pain), which resolves quickly with treatment. In some case of spinal DCS, what seems like peripheral neurologic symptoms on the trunk can progress rapidly to PARAPLEGIA so caution (in the form of aggressive treatment) is warranted. Involvement of the central nervous system can lead to permanent neurologic deficit if not recognized early and treated appropriately. It is critical to perform a thorough neurologic exam to detect subtle findings including neurocognitive deficits. Oftentimes patients judged to have only peripheral complaints prior to recompression will admit to a “HAZE” being lifted during recompression – this “haze” (mild disorientation, FLAT AFFECT, PERSONALITY CHANGE) should be considered a CNS symptom. Current literature suggests it is RARE for DCS symptoms to begin more than 24-48 HRS following decompression exposure. However, DCS should still be considered in the Differential Diagnosis for any individual presenting with DCS symptoms even beyond this period of time if they had a CREDIBLE EXPOSURE (i.e. at or above 18,000 ft or hyperbaric exposure).
Posted on: Wed, 27 Nov 2013 14:21:46 +0000
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