709 - Keys to the Bends: Analysis of Type 2 Decompression Sickness after Drastic Change in Altitude

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

JE

Jenzel Espares, DO

PM&R Resident Physician
Nassau University Medical Center
Seaford, New York, United States

Presenting Author(s)

BF

Brent Fogel, DO

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

JW

Justin Wang, MD

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
FB

Forrest Butensky, DO

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
CK

Chi Lam Kwok, MD

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
RC

Ricardo Cruz, MD

Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Submitter(s)

JE

Jenzel Espares, DO

Nassau University Medical Center
Seaford, New York, United States

Case Diagnosis: Caisson disease (Type 2 decompression sickness)

Case Description: A 24-year-old female developed dizziness, nausea, and right-sided pain after scuba diving in Aruba and flying the same day. Symptoms rapidly progressed to complete right sided hemiparesis and left leg weakness. She was immediately transferred to the ED, where stroke was ruled out via CT. She was diagnosed with decompression sickness and received hyperbaric oxygen therapy. Upon rehab admission, she had mild weakness in both arms (4/5), moderate leg weakness (3+/5), and right leg sensory deficits. Early hyperbaric treatment was crucial for her recovery.

Discussions: Decompression sickness (DCS) is caused by supersaturation of inert gas in the bloodstream and tissues. DCS used the common terms of “bends” for joint/skeletal pain, “chokes” for dyspnea, and “staggers” for neurological symptoms. DCS is stratified into Type I for symptoms involving only the skin, musculoskeletal system, or lymphatic system; while Type II incorporates manifestations of the cardiopulmonary and central nervous systems. Immediate administration of 100% oxygen and recompression (via hyperbarics) is deemed the standard treatment for minimizing morbidity and mortality.

Conclusions: This case demonstrates an interesting manifestation of type 2 decompression sickness, likely secondary to the large magnitude of pressure difference from below sea level to flight altitude. The patient underwent inpatient rehabilitation with improvement in gait ability and overall functional status, while continuing to undergo hyperbaric treatments in between therapy sessions. On admission, she was able to ambulate 12 steps with rolling walker and moderate assistance; upon discharge, the patient was able to ambulate 100 feet with no device under supervision/contact guard, and 130 feet with rolling walker under supervision. While permanent injury from DCS is possible, early intervention significantly improves outcomes and decreases likelihood for long-term effects. This case also highlights the efficacy of hyperbaric treatments to address and treat an acute brain injury.