Diving With Hydrocephalus and Shunt

Diving with hydrocephalus can be accomplished if several aspects of the problem are taken into account:

1. The extent of neurological disability; how much numbness of your extremities and whether or not there is any “autonomic” instability. This means things like postural hypotension, blood pressure changes and ability to react to cold water immersion.

2. All of the neurological deficits should be carefully documented so that a diving physician will have this information available in case of an accident.

3. If there is good circulation, a shunt should not be a problem since there is no air involved and there should be no pressure differentials from the changes in pressures of diving.

4. If there is an open wound you must be aware of the increased risk of infection from pathogens in the seawater.

Dr. Nick McIver advises:
“There are two main shunt types and the risks when diving do differ. UKSDMC advise that the shunt should be fully functional There should have been no evidence of recent infection, and no detectable neurological deficit on examination.

Ventriculo-peritoneal (V-P) shunts are considered less likely to cause problem when diving.

Ventriculo-atrial shunts (V-A) have a theoretically increased risk when diving of bubble formation at the point of shunt insertion, and a risk of shunt malfunction because of “extreme pressure change”. There is also considered a risk of epilepsy following V-A shunt insertion. The guidelines for epilepsy are already published and require that there should be no seizure over 5 years, and there should have been no requirement for anticonvulsant therapy for at least 5 years.”

Prof Michael Swash, Neuropathologist at the Royal London Hospital, sees no problem with having a shunt.

He does warn about pre-existing neurological disability and incapacity occurring under pressure; here he states a neurological report is needed: if there is any problem with breathing, hiccups, headache, or neurological disorder, e.g. spasticity, he would be cautious about diving.

He believes that poor functional reserve would be a problem should any DCI occur, and the diver should be warned of this.

He does not think there is any increased risk of DCI with the pathology mentioned, provided:

1. The hydrocephalus is quiescent

2. The ventricles are of normal size

3. There is no Chiari malformation

4. There is no syringomyelia

5. There is no significant neurological disability all of which may complicate any congenital malformation.

AUTHOR

Ernest S. Campbell, M.D., FACS

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