Additionally, a patent foramen ovale allows arterial gas emboli to cause further harm. ConclusionsÄecompression illness results as a sudden decrease in pressures during underwater ascent it is caused by nitrogen bubbles forming in tissue. Through a diagnosis of exclusion, decompression sickness was the conclusive diagnosis. Symptoms had slowly improved but he was left with a left arm motor weakness, and the team was left puzzled as to what could have caused his signs and symptoms. A leptospirosis and a vasculitis screen were both negative. A bubble echo confirmed a patent foramen ovale. A magnetic resonance imaging of his head revealed some deep periventricular ischaemic changes, old and new, however no signs of gas embolism or poor flow. His saturation had dropped to 91% on room air, and a computed tomography pulmonary angiogram revealed no obvious cause. Upon admission, his blood showed polycythaemia. He had another session in the hyperbaric oxygen chamber but to no success. A computed tomography of the head showed no signs of intracranial pathology. He attended the hyperbaric decompression chamber before attending the emergency department but to no resolve. Post-diving, he displayed typical symptoms of decompression illness. We present the case of a 42-year-old male from the West Midlands, UK, who attended the emergency department post-scuba diving with confusion, light-headedness, left arm weakness, and bilateral paraesthesia of the hands. Learning points to take are that decompression illness can present atypically, but one must exclude other causes. It takes into account the thought process of multiple systems and a multidisciplinary team approach. The case reinforces the importance of stepping back and looking at every possibility along with multiple co-existing pathologies.
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