Senin, 23 Juli 2012

Peripheral neuropathy of the extremity after hyperbaric exposure.

Peripheral neuropathy of the extremity after hyperbaric exposure.
BACKGROUND: Neurological deficits occurring after diving or hyperbaric exposure are typically due to central nervous system decompression illness (DCI). However, consideration of alternate diagnoses is sometimes warranted.
CASE REPORT: A 47-yr-old female hyperbaric technician developed foot drop 2 d following her last hyperbaric exposure. She had worked in chamber once daily at 45 fsw for 90 min. The breathing gas was air until the last 15 min, during which she breathed oxygen. Her history was complicated by a gastric bypass and weight loss totaling 160 pounds within the preceding 9 mo. She was treated for presumed neurological DCI without improvement. The adherence to safe hyperbaric protocols, delayed presentation, ongoing medical issues, and lack of response to therapy brought the diagnosis into question. Extensive neurological evaluation, including nerve conduction studies, revealed a common peroneal mononeuropathy. We concluded that her neuropathy was more likely due to extreme weight loss and malnutrition than peripheral nervous system DCI.
DISCUSSION: There are rare reports of DCI affecting the peripheral nerves of the extremities. A literature search revealed only three such cases. Two further reports describe peripheral neuropathy in the extremities of divers that were attributed to other causes: compression by a weight belt and vasculitis. However, peroneal neuropathy is one of the most common focal mononeuropathies of the lower extremity and has been reported in association with extreme weight loss and malnutrition. We attributed our diver's neuropathy to extreme weight loss and malnutrition rather than DCI.
Mary M Garland; Amparo Gutrierrez; Diana M Barratt
Related Documents :
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Aviation, space, and environmental medicine     Volume:  83     ISSN:  0095-6562     ISO Abbreviation:  Aviat Space Environ Med     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501714     Medline TA:  Aviat Space Environ Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  805-8     Citation Subset:  IM; S    
Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
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