Diagnosis Difficulty: DCI or Something Else

Diver experiences facial numbness and headache: DCI-related or another cause?

In this incident the symptoms that presented could have been attributed to several causes. This is a challenge DAN often faces when a diver calls for help.

A 63-year-old male was on a diving holiday in Papua New Guinea. A call was made to the DAN Diving Emergency Service (DES) Hotline as the diver was experiencing symptoms following two dives he completed the previous day:

  • Dive 1: Depth of 22 meters for a total dive time of 40 minutes, with a surface interval of 2 hours and 30 minutes.
  • Dive 2: Depth of 32 meters for a total dive time of 116 minutes. Long decompression with most of the dive spent at 24 meters.

Both dives were on Nitrox, with no issues noted on either dive.

Twenty minutes after the dive he developed a headache and then numbness around the left eye and around his mouth. The DAN diving doctor performed a neurological assessment over the phone, which the diver completed satisfactorily.

The DAN doctor suggested that the diver go to the local clinic for oxygen first aid. The clinic did not think his condition was DCI-related, so did not give him oxygen treatment. Doctors at a larger hospital advised he was likely to be experiencing DCI.

facial baroparesis (002)

The next day the diver’s symptoms progressed to numbness all over the right side of his face and a feeling of facial drooping. DAN staff was concerned that the diver had possibly experienced a stroke but were still not ruling out DCI. While there is a hyperbaric chamber in Port Moresby, DAN recommended the diver be evacuated to Townsville, QLD, for a higher level of care due to the ambiguity of his symptoms.

DAN asked that the diver remain breathing oxygen for as long as possible as the evacuation was organised. Once in Townsville the diver received a single chamber treatment, but there was no change in his symptoms.

After undergoing testing, the diver was diagnosed was Bell’s palsy, which the doctors believed could be coincidentally associated with diving. The diagnosis was reviewed by a neurologist, after which the diver was discharged to return home. Bell’s palsy is paralysis or weakness of the muscles on one side of the face. The exact cause is unknown and most people with Bell’s palsy recover completely with time.

DAN Comment

This incident highlights one of the challenges DAN faces when a call for help is received. The DAN Diving Doctor discusses with the diver:

  • Their dive profiles
  • The symptoms they are experiencing:
    • What they are
    • When they developed
    • Their progression – Have they become worse? Have new symptoms appeared?

Sometimes, from the information provided, it is not clear whether the diver is experiencing DCI and needs to receive recompression or whether the cause is attributed to another cause, such as stroke or a cardiovascular-related incident. The priority in these cases is to get the diver to higher-level care for further assessment and treatment.

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