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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Decompression sickness (DCS) is a well-known hazard of exposure to significant variations in ambient pressure. The diagnosis and management of DCS is frequently a source of confusion. Although the majority of cases are manifested by joint or limb pains (Type I DCS), patients may present with a wide array of symptoms, such as neurologic deficits, headache, fatigue, nausea, and respiratory difficulty. A thorough knowledge of the differential diagnosis and a strong index of suspicion are crucial to the proper management of DCS. Presented herein are two cases of altitude-related DCS which were confused initially with a viral syndrome. A discussion of the symptoms of DCS is included.
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PMID:Decompression sickness presenting as a viral syndrome. 199 34

Eighteen professional divers (age range 24-33 yr, mean 28.3) participated in one simulated dive to 360 meters of seawater (msw) in a helium-oxygen (heliox) atmosphere with equal compression and decompression profiles. All divers were given an extensive neurologic examination before diving. Clinical neurologic symptoms observed during the dives were equilibrium disorder, sleep disturbances, fatigue, nausea, loose stools, stomach pain, tremor, mental disturbances, reduced appetite, and headache. Symptoms were scored individually by each diver. The symptoms were analyzed statistically by factor analysis, which grouped them into four factors. These symptoms are presumably related to functional disturbances in the brain stem and the cerebellum. Factor 3 symptoms (tremor, mental disturbances, reduced appetite) correlated significantly to a history of predive decompression sickness (P = 0.006) and to cerebral concussion (P = 0.023). Three divers were periodically unable to work at bottom due to equilibrium disorder, diarrhea, or nausea. One diver with mild polyneuropathy and slight cerebral atrophy as seen by computerized tomography and another diver with abnormal electroencephalography were periodically unable to work due to equilibrium disorder and nausea, respectively. We advocate that divers with signs of central or peripheral nervous system dysfunction should not be selected for deep diving.
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PMID:Analysis of neurologic symptoms in deep diving: implications for selection of divers. 232 22

Type II altitude-related decompression sickness (DCS), due to its wide spectrum of symptoms, is often difficult to diagnose. This difficulty sometimes leads unnecessarily to the permanent grounding of an experienced aviator. So that this condition could be better understood, a total of 133 cases of Type II altitude DCS (on file at the United States Air Force Hyperbaric Medicine Division, School of Aerospace Medicine, Brooks AFB, TX) were reviewed. Most cases (94.7%) followed altitude chamber training. The most common manifestation was joint pain (43.6%), associated with headache (42.1%), visual disturbances (30.1%), and limb paresthesia (27.8%). The next most common symptoms were, in order of decreasing frequency: mental confusion (24.8%), limb numbness (16.5%), and extreme fatigue (10.5%). Spinal cord involvement, chokes, and unconsciousness were rare (6.9%, 6%, and 1.5%, respectively). Hyperbaric oxygen treatment produced fully successful results in 97.7% of the cases. Only 2.3% of the cases resulted in residual deficit; no deaths occurred. A thorough knowledge of the differential diagnosis and predisposing factors is essential to narrow the margins of error in the diagnosis and prevention of decompression sickness in the operational or training environment. A recommendation for favorable consideration of waiver action for those aviators who suffered Type II DCS is presented. These recommendations are based on a unique classification of the severity of symptoms.
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PMID:Type II altitude decompression sickness (DCS): U.S. Air Force experience with 133 cases. 265 1

Thirty-four healthy human subjects were exposed to shallow air saturation for 48 h [1.77 ATA (25.5 fsw) n = 19, 1.89 ATA (29.5 fsw) n = 15] and then decompressed to 1 ATA (0 fsw) in about 2 min. Symptoms included fatigue, limb and joint pain, headache, myalgias, and pruritus. No subject of 19 was diagnosed as having decompression sickness (DCS) after the shallower exposure, but 4 of 15 were diagnosed and treated for DCS subsequent to the deeper exposure. Almost all subjects in both groups had Doppler-detectable venous gas emboli (VGE) lasting up to 12 h postdecompression. Treated subjects had a recurrence of VGE several hours after the hyperbaric oxygen treatment. Only the duration of VGE, and not the VGE score, correlated with symptoms; and only the subjects body weight and age correlated with the VGE variables. This study indicates that hyperbaric air exposures of this magnitude are not as benign as previously thought.
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PMID:Direct ascent from shallow air saturation exposures. 353

This study identified the short- and long-term health effects among U.S. Navy divers (n = 328) who suffered decompression sickness (DCS) between January 1968 and December 1979 and compared their post-DCS hospitalization rates with a matched sample of divers (n = 1,086) who had no recorded diving accidents. Results identified 251 individuals (76.5%) whose records contained no diving-related medical events after the DCS incident; the other divers (23.5%) had records of a subsequent hospital admission and/or a physical disability separation. Only three physical disabilities were attributed to DCS or diving, and there were no DCS-related deaths. DCS divers had significantly higher rates than controls for total hospitalizations, symptoms and headache, and diseases of the arteries and veins. These two clusters, which included such conditions as pain in the joint, abnormal involuntary movement, pain in the limb, and arterial embolism, were identified as potential risks for divers who suffer a DCS mishap. Previous hospitalizations and age were not associated with DCS; however, divers in the DCS group were significantly heavier than all other divers.
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PMID:Consequences of U.S. Navy diving mishaps: decompression sickness. 377 71

A 52-year-old man presented to the emergency department with dysphasia and a headache after scuba diving. He was treated initially for decompression sickness. Subsequent workup revealed bilateral internal carotid artery dissection. The risk factors, presenting symptoms, diagnosis, and treatment of internal carotid artery dissection are reviewed. The importance of considering unusual causes of neurologic deficits after scuba diving is emphasized.
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PMID:Internal carotid artery dissection associated with scuba diving. 780 58

Although the use of fine-gauge spinal needles reduces the incidence of postdural puncture headache, they are associated with increased risk of placement failure as a result of deflection and bending. This in vitro study quantifies spinal needle deflection from the axis of insertion with respect to needle type, gauge, and tip bend. In addition to straight-tip needles, those with standardized 5 degrees and 10 degrees tip bends were studied. The purpose was to examine the effect of tip bend, which has been described with small gauge spinal needles after bony contact, on needle path deflection. Needles studied included Quincke (Q), Sprotte (S), and Whitacre (W) in sizes ranging from 18-gauge to 29-gauge. Needles were inserted perpendicularly into porcine paraspinous muscle followed by radiologic investigation. Measurements of needle deflection from the axis of insertion at depths of 20, 40, and 60 mm were performed in a blinded fashion. Straight-tip Q needle deflection, but not W or S, was correlated with gauge and depth of insertion. Although there were differences within needle type groups, needle deflection was generally correlated with the degree of tip bend. We conclude that spinal needle deflection is dependent on the type of needle (W < S < Q), and that the magnitude of deflection is related to gauge (large < small) and tip bend (straight < 5 degrees < 10 degrees).
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PMID:The effects of needle type, gauge, and tip bend on spinal needle deflection. 878 Mar 14

A 33-yr-old man came to the emergency department with the chief complaint of a severe headache and decreased sensation in his right hand following a deep dive on scuba. Physical examination before recompression treatment was remarkable only for hypesthesia on the right hand. We diagnosed type II decompression sickness and the patient underwent standard recompression therapy. The patient experienced near-complete resolution of his symptoms, his only residual complaint being that of neck pain with head movement. To investigate other causes of headache, a computed tomography of the head was performed which was normal, and a lumbar puncture was performed which was consistent with viral meningitis. This is the first reported case of recompression treatment on a patient with viral meningitis and decompression sickness.
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PMID:Case report on a diver with type II decompression sickness and viral meningitis. 898 55

This study concerns four cases of sinus pericranii observed at the Neurological Department of Nancy. Sinus pericranii is a direct communication between the outer surface of the skull and the intracranial venous sinuses. It may be congenital, acquired or traumatic. This abnormality, usually located in the midline and often in the frontal region, is usually symptomless, but some patients complain of headache, nausea and vertigo. Sinus pericranii shows as a fluctuating non pulsatile mass of reddish or bluish colour, expanding when the patient bends his head down. Radiography usually shows one or several bone defects opposite the lesion found at CT bone window. On soft tissue window the mass is not calcified and usually enhanced by contrast injection. It is sometimes possible to visualize the vascular communication between the extracranial region and the underlying dural sinus. When visualization is blurred, or CT shows intracerebral abnormalities, MRI examination is required. Angiography with subtraction in venous phase (40 to 60 seconds after the injection), sometimes aided by films taken in head down position. It is of interest only in cases where CT and MRI have shown associated vascular abnormalities. Otherwise, direct injection of contrast medium into the malformation makes it possible to assert the diagnosis of sinus pericranii and to determine the flow rate within the malformation, which to some extent commands the the therapeutic technique. In patients with small and asymptomatic sinus pericranii absention is the rule. When the sinus is of moderate size, and the flow rate not rapid and when there is no significant communication with the cerebral veins, endovascular sclerosis may be advocated. In all other cases, surgical removal is recommended and is usually easy.
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PMID:[Pericranial sinus]. 919 Mar 68

After the crash of TWA flight 800, U.S. Navy (USN) and civilian divers recovered the aircraft and the victims' remains from 117 feet of sea water (fsw). Safety information was gathered from observations, interviews, and medical and diving records. Of 752 dives employing surface decompression using oxygen (SDO2), 10 divers required recompression treatments, mainly for type 2 decompression sickness (DCS). When using hot water heating, the DCS risk was high until the dive profiles were modified. Divers made nearly 4,000 no-decompression scuba dives. In eight scuba divers and one tender treated with recompression, the diagnoses included DCS (3), arterial gas embolism (AGE) (1), and vascular headache (2). All USN divers recovered fully. The experience is consistent with previous work suggesting an increase in DCS risk in warmer SDO2 divers. The USN SDO2 tables can be made safer by limiting bottom time and extending decompression. Even under stressful conditions, rapid ascents resulting in AGE are uncommon. Vascular headaches can mimic DCS by responding to oxygen.
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PMID:Recompression treatments during the recovery of TWA Flight 800. 988 94


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