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RR17 - Neuro-behavioural impairment after neurological decompression illness

This report describes a study attempting to identify neuropsychological impairment in a group of recreational divers who have had an apparently satisfactory outcome from treatment for neurological Decompression Illness (DCI).

In 1959 Rozsahegyi (1,2) drew attention to long term neurological and psychological disabilities amongst a group of compressed air workers who had been treated for DCI acquired whilst building the Budapest Metro. Over a half the subjects were reported to display clinical features of "chronic encephalomyelopathy, vegetative neurosis, or psychosomatic symptoms". In 1976, Peters, Levin and Kelly (3) undertook a detailed assessment of cognitive and neurological function in a group of 20 divers with a history of neurological DCI and described a high incidence of abnormality. Both these studies challenged the belief - widely held at the time - that neurological DCI was primarily a condition of the spinal cord. Other studies have revealed similar findings (4,5,6). These, together with studies of the radiological (7), electrophysiological (8,9) and histological findings (10) associated with DCI have led to the present day model of a multi-focal disease from which no part of the central nervous system is immune. Moreover it has become clear that the standard bed-side neurological examination is at best a rough guide to the site and extent of the disease process.

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Updated 2010-03-19