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Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers

Markus Schwerzmann, MD; Christian Seiler, MD; Ernst Lipp, MD; Raphael Guzman, MD; Karl O. Lövblad, MD; Martin Kraus, MD; and Nils Kucher, MD
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From Swiss Cardiovascular Center Bern and University Hospital, Bern, Switzerland.

Acknowledgments: The authors thank Aija Kinnunen, Marika Kabok, and Liza Needergard for assistance with transesophageal echocardiography.

Requests for Single Reprints: Christian Seiler, MD, Swiss Cardiovascular Center Bern, Department of Cardiology, University Hospital, 3010 Bern, Switzerland; e-mail, christian.seiler.cardio@insel.ch.

Current Author Addresses: Drs. Schwerzmann, Seiler, Lipp, and Kucher: Swiss Cardiovascular Center Bern, Cardiology, University Hospital, 3010 Bern, Switzerland.

Drs. Guzman and Lövblad: Department of Neuroradiology, University Hospital Bern, 3010 Bern, Switzerland.

Dr. Kraus: Schweizerische Gesellschaft für Unterwasser-und Hyperbarmedizin, Rathausstrasse 11, 8570 Weinfelden, Switzerland.

Author Contributions: Conception and design: M. Schwerzmann, C. Seiler.

Analysis and interpretation of the data: M. Schwerzmann, C. Seiler, K. Lövblad.

Drafting of the article: M. Schwerzmann, C. Seiler.

Critical revision of the article for important intellectual content: M. Kraus.

Final approval of the article: C. Seiler.

Provision of study materials or patients: M. Schwerzmann, C. Seiler, E. Lipp, R. Guzman, N. Kucher.

Statistical expertise: M. Schwerzmann, C. Seiler.

Administrative, technical, or logistic support: M. Schwerzmann, C. Seiler, E. Lipp, R. Guzman, K. Lövblad, M. Kraus, N. Kucher.

Collection and assembly of data: M. Schwerzmann, C. Seiler, E. Lipp, K. Lövblad.

Ann Intern Med. 2001;134(1):21-24. doi:10.7326/0003-4819-134-1-200101020-00009
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Scuba diving involves a risk for neurologic injuries caused by decompression sickness, arterial gas embolism, anoxia, and the toxic effects of high partial pressure of breathing gases (1). Most neuroimaging studies for detection of ischemic brain lesions have been performed in divers with acute decompression-related injuries of the central nervous system (23). However, as a recent study has shown (4), most divers may be neurologically asymptomatic despite an increased prevalence of brain lesions compared with nondiving controls. Reul and colleagues (4) found 80% of all brain lesions in a subgroup of 27% of divers, possibly those with patent foramen ovale who had paradoxical arterial gas embolism during decompression (4). Knauth and coworkers (5) used transcranial Doppler ultrasonography to detect a right-to-left shunt in 87 sport divers; they reported that multiple brain lesions on magnetic resonance imaging (MRI) occurred exclusively in those with a large right-to-left shunt, which was presumed to be a patent foramen ovale (5). Detection of intravenously injected echocontrast bubbles in the cerebral vasculature is not specific for a patent foramen ovale; moreover, compared with transesophageal echocardiography, detection of these bubbles has been found to be only 68% sensitive in detecting a patent foramen ovale (6).

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Grahic Jump Location
Decompression sickness events and ischemic brain lesions in divers and nondivers.Top.white barsgray barsBottom.

Average number of decompression sickness events ( ) and arterial gas emboli ( ) and the frequency of these events per 10 000 dives. Average number of ischemic brain lesions seen on magnetic resonance imaging.

Grahic Jump Location




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Summary for Patients

Brain Lesions in Scuba Divers

The summary below is from the full report titled “Relation between Directly Detected Patent Foramen Ovale and Ischemic Brain Lesions in Sport Divers.” It is in the 2 January 2001 issue of Annals of Internal Medicine (volume 134, pages 21-24). The authors are M Schwerzmann, C Seiler, E Lipp, R Guzman, KO Lövblad, M Kraus, and N Kucher.


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