Brendan Winkle* and Johnny Efendi
Introduction: Here we describe an unusual case of Chronic Subdural Haematoma (CSDH) caused by a combination of scuba diving followed by flying in a helicopter and highlight the previously undocumented risks associated with each of these activities.
Summary of background data: Subdural haematoma (SDH) is characterised by haemorrhage into the spaces surrounding the brain. The incidence of CSDH is higher in the elderly population and frequently traumatic in origin. Other risk factors include anticoagulant use, previous traumatic brain injury, cerebral metastases, aneurysm rupture, chronic alcohol abuse and heavy cocainese. While case reports describing epidural haematoma secondary to scuba-diving exist, no case reports describing scuba-diving related SDH can be found in the current literature.
Method: A 50 year old male presented to his General Practitioner with a 3 month history of headache, whose onset coincided with a recreational scuba-dive followed by a helicopter flight the following day. Magnetic Resonance Imaging (MRI) scan of his head and neck revealed a large SDH with midline shift and mass effect. Immediate hospitalisation with operative management ensued and the patient made a full recovery. Review of the literature did not reveal any previous cases of SDH caused by either scuba diving or helicopter flight.
Conclusion: Scuba-diving and flying in a helicopter can precipitate SDH. The risk of this is likely to be amplified by a combination of the two activities. SDH can be caused by the pressure changes associated with scuba diving and with helicopter flying. This risk may be amplified by a combination of the two.
