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Difficult areas in forensic neuropathology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Christopher Milroy, Helen Whitwell
Investigation of diving deaths is complex. There has been an increase in deaths occurring during recreational diving with a downturn in occupational deaths. Detailed discussion about the investigation of these is covered in detail by Ross in The Pathology of Trauma (Ross and Grieve 2000). Decompression illness is seen in divers who fail to control their rate of ascent. It comprises pulmonary barotrauma and cerebral gas embolism. Bubbles of inert gas come out of solution during decompression. Cerebral symptoms range from dizziness to unconsciousness, with spinal cord involvement manifesting as paraesthesias/numbness. The lower spinal cord is particularly affected and damage may be permanent. Pathology shows acute infarcts typically in lateral and dorsal columns (Calder 1986) (Figure 17.8). Chronic damage may also be seen in the absence of overt illness (Palmer et al. 1987).
Ear Trauma
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Organs with high metabolic rates and unit blood flow, such as the stria vascularis, are more susceptible.347,348 Isolated vestibular or hearing symptoms are rare. A history of other symptoms attributable to a decompression illness should be sought. Localized pain (91.8%), numbness or paraesthesia (21.2 %), muscular weakness (20.6%) and skin rash (14.9%) are the most frequently described. Non-specific dizziness or vertigo was the fifth most common (8.5%) with auditory disturbance occurring in only 0.3%.349
Discovery of caisson disease: a dive into the history of decompression sickness
Published in Baylor University Medical Center Proceedings, 2022
Scott Ninokawa, Kristen Nordham
Decompression sickness, or decompression illness, is the result of rapid decompression causing bubbles to form in the body’s blood and vital tissues. It is commonly referred to in the context of SCUBA diving accidents, but can affect pilots, parachutists, miners, and anyone who is exposed to rapid reductions in barometric pressure. Inert gases, such as nitrogen, are dissolved in the blood and absorbed by various tissues throughout the body in proportion to the surrounding environmental pressures. If this pressure is reduced quickly, termed decompression, the nitrogen can form bubbles, which wreak havoc on various tissues of the body, causing arthralgias, dyspnea, pruritus, confusion, seizures, and paralysis. If left untreated, most minor cases resolve on their own, but severe cases can cause death if not managed emergently.4 This disease was a mysterious ailment faced by miners in France in the early 1800s, but today it is well described with scientific tables and complex physics calculations that allow for its prevention. This disease resulted in numerous deaths of industrial laborers, caused disability of physicians, and was the source of many myths and homeopathic remedies.
Amplatzer patent foramen ovale occluder: safety and efficacy
Published in Expert Review of Medical Devices, 2019
Raouf Madhkour, Andreas Wahl, Fabien Praz, Bernhard Meier
PFO is a risk factor for developing decompression illness in divers. Various observational studies showed that silent cerebral defects detected by magnetic resonance imaging are less frequent in divers without PFO than in those with [42,43]. In fact, during the ascent of the diver, pre-existing gas nuclei found at normal atmospheric pressure in different parts of the body expand and may enter the venous circulation through migration to capillary or lymphatic vessels. In the normal state, small gas volumes are filtered by the lungs and exhaled. In contrast, in the presence of a right to left shunt via a PFO, these gas bubbles can cross over to the arterial circulation resulting in systemic gas embolism.
Patent Foramen Ovale Closure, A Contemporary Review
Published in Structural Heart, 2018
Raouf Madhkour, Bernhard Meier
The PFO plays a role in migraine. A retrospective cohort study of 603 patients with percutaneous PFO closure showed a marked improvement of migraine symptoms.30 Headache was alleviated in 48% of patients and disappeared completely in 34% of patients. This is in keeping with other series31,32 and randomized data.33,34 Microemboli or, more likely, serotonin gushes stimulating one or more oversensitive receptors in the brain may be accountable for that. Decompression illness