Pseudotumor Cerebri

Diving Concerns

Condition Related

The pressures of diving would have no effect on the intracranial pressure. The increased intracranial pressure causes symptoms that can be confused with those of decompression sickness – headache, tinnitus, nausea and vomiting. It also causes loss of vision.

Treatment Related

Treatment is by osmotic diuresis, diuretics, spinal taps and the placement of a drainage tube from the lower spinal canal into the abdomen.

Diver Related

Loss of vision occurs as a major effect of the condition. Nausea and vomiting are an underwater risk. Headache, ringing in the ears mimic decompression sickness.

Diving Risk Assessment

Risk from the Condition
Diving would not adversely affect the condition.

Risks from the Treatment
Diuretics can cause dehydration, a known increased risk for decompression sickness.

Spinal taps are minimally invasive but the puncture wound seals rapidly unless there is a spinal fluid leak.

Incompletely healed incisions from tube insertion would be a risk.

Risks to the Diver
Given a diver with good vision, there would be few risks to the diver. Poor vision would adversely affect the diver and buddy safety. A well hydrated diver would have little risk.

Advising the Diver

Potential for injury from future diving
Very small increase in risk for the diver with stable visual acuity, who is well hydrated and who has recorded all symptoms prior to diving for future comparison.

Modifiers

Degree of disability
Respose to treatment
Need to dive; recreational, work related.

Dive or not dive
Physically stressful diving should probably be restricted, both in sport diving and work diving due to the possibility of increased intracranial pressure from straining. If there is difficulty clearing with excessive use of the Valsalva maneuver, there would be an associated increase in ICP.Alternate methods for clearing should be taught and used.

There are no Medline references to this condition in relationship to scuba diving. As you might expect, there are also no articles or treatises – that I can find. The over riding fact is that intracranial pressure is not elevated by depth/pressure. Because of this, if you are in a stable situation and not worsening, with good visual acuity – then you probably should be certified as fit to dive.

AUTHOR

Ernest S. Campbell, M.D., FACS

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