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> > > > Cohort study of multiple brain lesions in sport > > divers: role of a patent foramen ovale [see > comments] > > > > Knauth M; Ries S; Pohimann S; Kerby T; Forsting M; > > Daffertshofer M; Hennerici M; Sartor K > > > > BMJ 1997 Mar 8;314(7082):701-5 > > Comment in: BMJ 1997 Mar 8;314(7082):689-90 > > Comment in: BMJ 1997 Jun 14;314(7096):1761; > > discussion 1761-2 > > > > ABSTRACT: > > OBJECTIVE: To investigate the role of a patient > > foramen ovale in the pathogenesis of multiple > brain > > lesions acquired by sport divers in the absence of > > reported decompression symptoms. > > > > DESIGN: Prospective double blind cohort study. > > > > SETTING: Diving clubs around Heidelberg and > > departments of neuroradiology and neurology. > > > > SUBJECTS: 87 sport divers with a minimum of 160 > scuba > > dives (dives with self contained underwater > breathing > > apparatus). > > > > MAIN OUTCOME MEASURES: Presence of multiple brain > > lesions visualised by cranial magnetic resonance > > imaging and presence and size of patent foramen > ovale > > as documented by echocontrast transcranial Doppler > > ultrasonography. > > > > RESULTS: 25 subjects were found to have a > > right-to-left shunt, 13 with a patent foramen > ovale of > > high haemodynamic relevance. A total of 41 brain > > lesions were detected in 11 divers. > > > > There were seven brain lesions in seven divers > without > > a right- to-left shunt and 34 lesions in four > divers > > with a right-to-left shunt. Multiple brain lesions > > occurred exclusively in three divers with a large > > patent foramen ovale (P = 0.004). > > > > CONCLUSIONS: Multiple brain lesions in sport > divers > > were associated with presence of a large patent > > foramen ovale. This association suggests > paradoxical > > gas embolism as the pathological mechanism. A > patent > > foramen ovale of high haemodynamic relevance seems > to > > be an important risk factor for developing > multiple > > brain lesions in sport divers. > > > > > > ***************************** > > COMMENT: It is noteworthy that Of the 87 divers in the study, 62 (~70%)had no shunt, while 25 (~30%) did. Also only of those w/ a shunt about 50% had a 'significant' shunt. Looking @ the cases w/ lesions: A total of 11 (~13%) showed lesions, Of that total, 7 (~65%) came from the no shunt group, 4 (~35%) came from the group w/ a shunt, albeit the latter group had < lesions/diver. Then again those multiple lesions were restricted to those w/ significant 'shunts'. Thus the issue appears to B not the presence or absence of shunts, but their sizes. Issues that come to mind is the paradoxical gas embolization in intact divers & the absence of S&S secondary that. That becomes scary unless the lesions registered R benign. Safe bubbles Esat Atikkan __________________________________________________ Do You Yahoo!? Thousands of Stores. Millions of Products. All in one place. Yahoo! Shopping: http://shopping.yahoo.com -- Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.
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