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Emmanuel Gempp - One of the best experts on this subject based on the ideXlab platform.

  • Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers
    Spinal Cord, 2014
    Co-Authors: Emmanuel Gempp, M Hugon, Pierre Louge, T Lafolie, S Demaistre, J E Blatteau
    Abstract:

    Study design: Retrospective case-control study Objectives: The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in Spinal canal stenosis, Spinal Cord lesions and the development of Spinal Cord Decompression sickness (DCS) in scuba divers. Setting: Referral hyperbaric facility, Toulon, France. Methods: We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense Cord lesions in relation with the accident and the recovery status at 6 months were also assessed. Results: Canal Spinal narrowing was more common in injured divers than in controls (79% vs 50%, OR=3.7 [95% CI, 1.3–10.8], P =0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of Spinal Cord Decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6–99], P =0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal Cord abnormalities and a negative clinical outcome. Conclusions: These results suggest that divers with cervical and thoracic Spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of Spinal Cord Decompression sickness.

  • Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers.
    Spinal cord, 2013
    Co-Authors: Emmanuel Gempp, M Hugon, Pierre Louge, T Lafolie, S Demaistre, Jeaneric Blatteau
    Abstract:

    Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers

  • mri features of Spinal Cord Decompression sickness presenting as a brown sequard syndrome
    Diving and Hyperbaric Medicine, 2012
    Co-Authors: Pierre Louge, Emmanuel Gempp, M Hugon
    Abstract:

    : Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of Spinal Cord Decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical Cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior Spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.

  • prognostic factors of Spinal Cord Decompression sickness in recreational diving retrospective and multicentric analysis of 279 cases
    Neurocritical Care, 2011
    Co-Authors: Jeaneric Blatteau, Emmanuel Gempp, O Simon, M Coulange, B Delafosse, V Souday, G Cochard, J Arvieux, A Henckes, Pierre Lafere
    Abstract:

    Background This study aims to determine the potential risk factors associated with the development of severe diving-related Spinal Cord Decompression sickness (DCS).

  • risk factors and treatment outcome in scuba divers with Spinal Cord Decompression sickness
    Journal of Critical Care, 2010
    Co-Authors: Emmanuel Gempp, Jeaneric Blatteau
    Abstract:

    Purpose: This study was designed to determine the recompression strategy and the potential risk factors associated with the development of severe diving-related Spinal Cord Decompression sickness (DCS). Material and methods: Sixty-three injured recreational divers (52 men and 11 women; 46 ± 12 years) presenting with symptoms of Spinal involvement were retrospectively included. Diving information, symptom latency after dive completion, and time interval between symptom onset and hyperbaric treatment were studied. The severity of Spinal Cord DCS was rated numerically for both the acute event and 1-month later. Initial recompression treatment at 2.8 atmosphere absolute (ATA) with 100% oxygen breathing or deeper recompression at 4 atmosphere absolute with nitrogen-oxygen or helium-oxygen breathing mixture was also noted. Results: Twenty-one divers (33%) had incomplete resolution after 1 month. The clinical severity at presentation was the only independent predictor of poor outcome (odd ratio, 2.68; P b .033). Time to treatment did not influence the recovery with a similar median delay (3 hours) between the divers with or without long-term sequelae. Choice of recompression procedure was not also a determinant factor for treatment outcome. Conclusion: The initial clinical course before treatment is a major prognostic factor of Spinal Cord DCS. Delay to recompression less than 3 hours and use of deep treatment tables did not improve outcome in DCS divers. © 2009 Published by Elsevier Inc.

Jeaneric Blatteau - One of the best experts on this subject based on the ideXlab platform.

Pierre Louge - One of the best experts on this subject based on the ideXlab platform.

  • Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers
    Spinal Cord, 2014
    Co-Authors: Emmanuel Gempp, M Hugon, Pierre Louge, T Lafolie, S Demaistre, J E Blatteau
    Abstract:

    Study design: Retrospective case-control study Objectives: The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in Spinal canal stenosis, Spinal Cord lesions and the development of Spinal Cord Decompression sickness (DCS) in scuba divers. Setting: Referral hyperbaric facility, Toulon, France. Methods: We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense Cord lesions in relation with the accident and the recovery status at 6 months were also assessed. Results: Canal Spinal narrowing was more common in injured divers than in controls (79% vs 50%, OR=3.7 [95% CI, 1.3–10.8], P =0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of Spinal Cord Decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6–99], P =0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal Cord abnormalities and a negative clinical outcome. Conclusions: These results suggest that divers with cervical and thoracic Spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of Spinal Cord Decompression sickness.

  • Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers.
    Spinal cord, 2013
    Co-Authors: Emmanuel Gempp, M Hugon, Pierre Louge, T Lafolie, S Demaistre, Jeaneric Blatteau
    Abstract:

    Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers

  • mri features of Spinal Cord Decompression sickness presenting as a brown sequard syndrome
    Diving and Hyperbaric Medicine, 2012
    Co-Authors: Pierre Louge, Emmanuel Gempp, M Hugon
    Abstract:

    : Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of Spinal Cord Decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical Cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior Spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.

  • Current management of diving-related Spinal Cord Decompression sickness in 2010
    Presse medicale (Paris France : 1983), 2010
    Co-Authors: Pierre Louge, Emmanuel Gempp, Pascal Constantin, M Hugon
    Abstract:

    The outcome of Spinal Cord Decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the aggravation of symptoms during the transfer to the hyperbaric facility and the emergence of sphincter dysfunction are predictive of poor prognosis whatever the treatment undertaken.

  • Relation Between Right-to-Left Shunts and Spinal Cord Decompression Sickness in Divers.
    International Journal of Sports Medicine, 2008
    Co-Authors: Emmanuel Gempp, J E Blatteau, E. Stephant, Pierre Louge
    Abstract:

    The role of right-to-left shunting (RLS) in Spinal Cord Decompression sickness (DCS) remains uncertain and could differ acCording to the distribution of lesion in Spinal Cord with a higher risk of upper Spinal Cord involvement in divers presenting a large patent foramen ovale. The aims of this study were to assess the prevalence of RLS with transcranial doppler ultrasonography in 49 divers referred for Spinal Cord DCS and compare it with the prevalence of RLS in 49 diving controls, and to determine a potential relation between RLS and lesion site of Spinal Cord. The proportion of large RLS was greater in DCS divers than in healthy control divers (odds ratio, 3.6 [95 % CI, 1.3 to 9.5]; p = 0.017). Shunting was not associated with the increased incidence of cervical Spinal Cord DCS (OR, 1.1 [95 % CI, 0.3 to 3.9]; p = 0.9) while a significant relationship between large RLS and Spinal Cord DCS with thoracolumbar involvement was demonstrated (OR, 6.9 [95 % CI, 2.3 to 20.4]; p < 0.001). From the above results, we conclude that the risk of Spinal Cord DCS in divers with hemodynamically relevant RLS is higher than in divers without RLS, particularly in their lower localization.

Timothy Chryssikos - One of the best experts on this subject based on the ideXlab platform.

J E Blatteau - One of the best experts on this subject based on the ideXlab platform.

  • Relation between cervical and thoracic Spinal canal stenosis and the development of Spinal Cord Decompression sickness in recreational scuba divers
    Spinal Cord, 2014
    Co-Authors: Emmanuel Gempp, M Hugon, Pierre Louge, T Lafolie, S Demaistre, J E Blatteau
    Abstract:

    Study design: Retrospective case-control study Objectives: The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in Spinal canal stenosis, Spinal Cord lesions and the development of Spinal Cord Decompression sickness (DCS) in scuba divers. Setting: Referral hyperbaric facility, Toulon, France. Methods: We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense Cord lesions in relation with the accident and the recovery status at 6 months were also assessed. Results: Canal Spinal narrowing was more common in injured divers than in controls (79% vs 50%, OR=3.7 [95% CI, 1.3–10.8], P =0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of Spinal Cord Decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6–99], P =0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal Cord abnormalities and a negative clinical outcome. Conclusions: These results suggest that divers with cervical and thoracic Spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of Spinal Cord Decompression sickness.

  • Relation Between Right-to-Left Shunts and Spinal Cord Decompression Sickness in Divers.
    International Journal of Sports Medicine, 2008
    Co-Authors: Emmanuel Gempp, J E Blatteau, E. Stephant, Pierre Louge
    Abstract:

    The role of right-to-left shunting (RLS) in Spinal Cord Decompression sickness (DCS) remains uncertain and could differ acCording to the distribution of lesion in Spinal Cord with a higher risk of upper Spinal Cord involvement in divers presenting a large patent foramen ovale. The aims of this study were to assess the prevalence of RLS with transcranial doppler ultrasonography in 49 divers referred for Spinal Cord DCS and compare it with the prevalence of RLS in 49 diving controls, and to determine a potential relation between RLS and lesion site of Spinal Cord. The proportion of large RLS was greater in DCS divers than in healthy control divers (odds ratio, 3.6 [95 % CI, 1.3 to 9.5]; p = 0.017). Shunting was not associated with the increased incidence of cervical Spinal Cord DCS (OR, 1.1 [95 % CI, 0.3 to 3.9]; p = 0.9) while a significant relationship between large RLS and Spinal Cord DCS with thoracolumbar involvement was demonstrated (OR, 6.9 [95 % CI, 2.3 to 20.4]; p < 0.001). From the above results, we conclude that the risk of Spinal Cord DCS in divers with hemodynamically relevant RLS is higher than in divers without RLS, particularly in their lower localization.