Radiologically isolated syndrome
Feb. 18, 2023
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CT scan of the brain in a 31-year-old man working as an underwater fisherman showing a hypodense lesion in the medial left frontal lobe due to decompression sickness. The patient presented with symptoms of paresthesia and difficulty writing. While spearfishing the day before admission, he developed fatigue, headache, and paresthesia, and weakness of the right hemibody. He also reported feeling “confused” and “disoriented” and had difficulty getting out of the water. The patient’s dive profile consisted of a 3-hour dive at a maximum depth of 30 meters, with interimmersion periods of less than 2 minutes on the surface and breath-hold times longer than 2 minutes. Two days earlier he had made another dive of 4 to 5 hours at a similar maximum depth and with a similar dive profile. Neurosonological studies (ie, carotid and vertebral ultrasound and transcranial Doppler studies) of supra-aortic and intracranial arteries showed no atheromatosis or significant hemodynamic alterations. Transthoracic echocardiography was normal, including a negative agitated saline contrast study to assess for a for right-to-left shunt. Total body CT scan showed no evidence of a neoplastic process. (Source: Sánchez-Villalobos JM, Fortuna-Alcaraz ML, Serrano-Velasco L, et al. Breath-hold diving-related decompression sickness with brain involvement: from neuroimaging to pathophysiology. Tomography 2022;8:1172-83. Creative Commons Attribution License [CC BY], https://creativecommons.org/licenses/by/4.0.)