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Stroke

STROKES (or Cerebrovascular Event (CVE) and Mini-strokes (Transient Ischaemic Attack)

What is a Stroke?

A stroke is when blood supply to part of the brain is cut off. Oxygen levels drop (ischaemia) and the brain cells start to die (infarct). Most commonly in the UK this is due to a blood clot but can be caused by bleeding into the brain or other rare causes such as fat or air. Symptoms depend on what part of the brain is affected.  They include limb weakness and numbness, facial paralysis, visual disturbances and visual or speech disturbances. For example, if the part controlling someone’s right arm movement is receiving no oxygen then they will be unable to move their right arm normally. Some people recover completely, others are left with long term symptoms.

Common risk factors for having a stroke include high blood pressure, high cholesterol, diabetes and smoking.

Can I dive if I have had a stroke?

Unfortunately, it may be dangerous to their health for a person to undertake scuba diving. Some people however make a good recovery but need to be on medication to control their risk factors.  Each person needs to be assessed individually.  You will need to contact a diving doctor to discuss your stroke and what happened to you. At this point the doctor may recommend it is time to hang up your fins or recommend that it is worth proceeding to a diving medical. 

There are a few major issues that need to be considered.

Firstly, often stroke happens due to multiple underlying problems, e.g. Diabetes / high cholesterol / high blood pressure.  An assessment of the chance of you having another stroke is needed from your specialist or GP. If you are considered high risk then there is a high chance you might have another stroke or another cardiovascular event, such as a heart attack. A stroke or heart attack underwater may be fatal.  See our section Cardiovascular Risk Factors (High Cholesterol / High Blood Pressure / Smoking

Secondly, if you have residual symptoms, this represents brain tissue that has been permanently damaged.  The brain has less capacity to deal with any further damage so an episode of decompression illness could result in serious disability. You would need to be examined to know what your baseline function is.

Finally, some residual problems are not compatible with safe diving. Cognitive problems such as poor memory, difficulty communicating or processing information will mean an individual should not dive again.

What will the doctor need to know?

We will need background information to consider your case. This list is not exhaustive or essential in every case but can be very helpful.

  1. Please bring any documentation you can from the hospital or your GP such as discharge or outpatient letters to explain the medical background and results of any investigations, such as scans, you have had.
  2. Blood tests to help us assess your risk as mentioned above. Your GP will probably have done these already, i.e.  Kidney blood test, Cholesterol and glucose test (fasting or HbA1c)
  3. Blood pressure information from GP - this may include a 24 hour BP reading.
  4. If you have a history of high blood pressure - a urine test for ACR, an assessment of the amount of protein in your urine, would be helpful (again your GP will often have done this).
  5. A list of all the medications you are on and summary of past medical history. Your GP reception should be able to print this out as a summary profile for you.  

Attendance for a medical does not mean that the doctor will recommend that you return to diving. Some individuals may be able to be return to diving with restrictions on the type of diving they do.

TRANSIENT ISCHEMIC ATTACK (TIA or mini stroke)

What is a TIA?

A TIA or mini stroke is caused by a temporary blockage of a blood vessel that supplies the brain. That part of the brain does not receive enough oxygen (ischaemia) and results in symptoms similar to a stroke but the difference being that symptoms are transient, lasting no more than 24 hours. If you have had a TIA it is important to seek urgent medical advice as you are at an increased risk of having a stroke in the near future.  

Can I dive if I have had a TIA?

After a TIA it is important to receive follow-up medical care. You will need further tests and may need to have surgery following your TIA to open up the arteries that supply blood to your brain. You should not dive following a TIA, until you have taken advice from your consultant and have a dive medical prior to returning to the water.

What will the doctor need to know?

The same applies as stated in the stroke section above.

 

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