An uncommon form of neurologic decompression sickness is cerebral air gas embolism (CAGE).
This is distinct from neurologic decompression sickness due to formation of microbubbles in the blood, which is more common.
Physiology: Air emboli (or bubbles of nitrogen gas) that normally are stopped in the lung circulation reach the brain. This requires either:
(1) intracardiac right-to-left shunt (patent foramen ovale, other)
(2) intrapulmonary shunt
The air bubble may damage the endothelium of the cerebral circulation, with delayed thrombosis and stroke.
Manifestations:
(1) symptoms of other forms of decompression sickness (middle ear barotrauma, respiratory symptoms, etc)
(2) hemi-anesthesia and/or unilateral weakness
(3) cognitive impairment
(4) impaired balance
