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Correlation between patent foramen ovale, cerebral "lesions" and neuropsychometric testing in experienced sports divers: does diving damage the brain?
Balestra, C.; Germonpré, P. (2016). Correlation between patent foramen ovale, cerebral "lesions" and neuropsychometric testing in experienced sports divers: does diving damage the brain? Frontiers in Psychology 7. https://hdl.handle.net/10.3389/fpsyg.2016.00696
In: Frontiers in Psychology. Frontiers Media: Lausanne. ISSN 1664-1078, more
Peer reviewed article  

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Author keywords
    adverse effects; SCUBA diving; PFO; embolism; long term effects

Authors  Top 
  • Balestra, C., more
  • Germonpré, P., more

Abstract
    SCUBA diving exposes divers to decompression sickness (DCS). There has been considerable debate whether divers with a Patent Foramen Ovale of the heart have a higher risk of DCS because of the possible right-to-left shunt of venous decompression bubbles into the arterial circulation. Symptomatic neurological DCS has been shown to cause permanent damage to brain and spinal cord tissue; it has been suggested that divers with PFO may be at higher risk of developing subclinical brain lesions because of repeated asymptomatic embolization of decompression-induced nitrogen bubbles. These studies however suffer from several methodological flaws, including self-selection bias. We recruited 200 volunteer divers from a recreational diving population who had never suffered from DCS; we then randomly selected 50 of those for further investigation. The selected divers underwent brain Magnetic Resonance Imaging to detect asymptomatic brain lesions, contrast trans oesophageal echocardiography for PFO, and extensive neuro-psychometric testing. Neuro-psychometry results were compared with a control group of normal subjects and a separate control group for subjects exposed to neurotoxic solvents. Forty two divers underwent all the tests and are included in this report. Grade 2 Patent Foramen Ovale was found in 16 (38%) of the divers; brain Unidentified Bright Objects (UBO's) were found in 5 (11.9%). There was no association between PFO and the presence of UBO's (P = 0.693) or their size (p = 0.5) in divers. Neuropsychometric testing in divers was significantly worse from controls in two tests, Digit Span Backwards (DSB; p < 0.05) and Symbol-Digit-Substitution (SDS; p 0.01). Compared to subjects exposed to neurotoxic solvents, divers scored similar on DSB and SDS tests, but significantly better on the Simple Reaction Time (REA) and Hand-Eye Coordination (EYE) tests. There was no correlation between PFO, number of UBO's and any of the neuro-psychometric tests. We conclude that for uneventful recreational diving, PFO does not appear to influence the presence of UBO's. Diving by itself seems to cause some decrease of short-term memory and higher cognitive function, including visual motor skills; this resembles some of the effects of nitrogen narcosis and we suggest that this may be a prolonged effect of diving.

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