{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:16:55Z","timestamp":1791415015132,"version":"4.3.3"},"reference-count":25,"publisher":"BMJ","issue":"7082","license":[{"start":{"date-parts":[[1997,3,8]],"date-time":"1997-03-08T00:00:00Z","timestamp":857779200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1997,1,16]]},"published-print":{"date-parts":[[1997,3,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    To investigate the role of a patent foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design:<\/jats:bold>\n                    Prospective double blind cohort study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting:<\/jats:bold>\n                    Diving clubs around Heidelberg and departments of neuroradiology and neurology.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects:<\/jats:bold>\n                    87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures:<\/jats:bold>\n                    Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P=0.004).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text position=\"float\">\n                      <jats:sec>\n                        <jats:title>Key messages<\/jats:title>\n                        <jats:list list-type=\"bullet\">\n                          <jats:list-item>\n                            <jats:p>An increased prevalence of multiple brain lesions has been reported in scuba divers compared with non-diving controls<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>It has been suggested that the brain lesions were due to arterial gas embolism and that the gas emboli could have entered the arterial circulation via a patent foramen ovale<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>We investigated this hypothesis in volunteer sport divers who had made at least 160 scuba dives<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>Brain lesions occurred in divers even in the absence of reported decompression sickness<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>Multiple brain lesions occurred exclusively in divers with a large patent foramen ovale<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>The association of multiple brain lesions with a large patent foramen ovale suggests paradoxical gas embolism as the pathological mechanism<\/jats:p>\n                          <\/jats:list-item>\n                        <\/jats:list>\n                      <\/jats:sec>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1136\/bmj.314.7082.701","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:45:43Z","timestamp":1319744743000},"page":"701","source":"Crossref","is-referenced-by-count":149,"title":["Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale"],"prefix":"10.1136","volume":"314","author":[{"given":"Michael","family":"Knauth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Ries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Pohimann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Kerby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Forsting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Daffertshofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hennerici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Sartor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1997,3,8]]},"reference":[{"key":"2025122313204492000_314.7082.701.1","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/0013-4694(91)90127-P","article-title":"Electroencephalography, evoked potentials and MRI brain scans in saturation divers. 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