Key result
Omitted decompression diving with a PFO triggers severe neurological decompression sickness and multifocal embolic infarcts.
Case Report (n=1)
High venous bubble load from provocative decompression may cause increased pulmonary artery pressure, RV dilatation, and right-to-left shunting across a PFO, leading to severe neurological decompression sickness.
Warrants caution for divers with PFO after provocative decompression; leaves open the role of right-to-left shunting in neurological DCS.
We present the case of a 28-year-old female diver who performed a scuba air dive with significant omitted decompression obligation. She developed constitutional and neurological symptoms. Brain magnetic resonance imaging post treatment demonstrated multifocal embolic infarcts and transthoracic echocardiogram with bubble contrast on day three revealed a persistent foramen ovale (PFO) and severe right ventricular (RV) dilatation. We postulate that the high venous bubble load from the provocative decompression caused an increase in pulmonary artery pressure, leading to RV dilatation and increased right to left shunting of bubbles across her PFO, resulting in significant neurological deficits. This mechanism is analogous to that seen in acute thromboembolic pulmonary embolism.
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Mason et al. (2025) conducted a case report in Severe neurological decompression sickness (n=1). Scuba air dive with significant omitted decompression obligation was evaluated on Severe neurological decompression sickness, multifocal embolic infarcts, and right ventricular dilatation. A scuba air dive with significant omitted decompression obligation in a patient with a persistent foramen ovale led to severe neurological decompression sickness and multifocal embolic infarcts.
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