{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:05:00Z","timestamp":1789614300252,"version":"build-2803163510"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T00:00:00Z","timestamp":1727136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>Breath-hold diving is a challenging activity that can lead to serious and dangerous complications, such as the \u201cTaravana\u201d syndrome. This syndrome is characterized by the onset of neurological symptoms after deep or repeated dives. The main clinical manifestations are cerebral, including stroke and cognitive impairment. The pathophysiology of Taravana syndrome is still widely debated, but the most accepted theory is that it is a specific form of decompression sickness. We have reviewed the main theories explaining the onset of Taravana syndrome and, through the description of a particularly illustrative case of a freediver using an underwater scooter, we have formulated a hypothesis according to which micro-bubbles formed directly in cerebral structures would be at the origin of this syndrome. MRI showed diffuse encephalopathy with vasogenic edema. Analysis of the radiological sequences did not suggest an ischemic or embolic mechanism. This finding is likely to be associated with the diagnosis of posterior reversible encephalopathy syndrome. The rapid ascent speeds associated with underwater scooter use could potentially result in the formation of nitrogen micro-bubbles in the capillaries of brain tissue. The emergence of scooters in freediving can be a hazard because of their ability to facilitate very rapid ascents. It is therefore essential to take preventive measures to ensure the safety of users of these devices.<\/jats:p>","DOI":"10.3389\/fphys.2024.1478650","type":"journal-article","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T04:43:06Z","timestamp":1727152986000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Taravana syndrome and posterior reversible encephalopathy syndrome: a microbubble hypothesis for neurological accidents in breath-hold divers"],"prefix":"10.3389","volume":"15","author":[{"given":"Arnaud","family":"Druelle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Castagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Roffi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Louge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Faivre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Eric","family":"Blatteau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1002\/ccr3.1479","article-title":"Two episodes of Taravana syndrome in a breath-hold diver with hyperhomocysteinemia","volume":"6","author":"Accurso","year":"2018","journal-title":"Clin. Case Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"463","DOI":"10.3389\/fneur.2020.00463","article-title":"Posterior reversible encephalopathy syndrome (PRES): pathophysiology and neuro-imaging","volume":"11","author":"Anderson","year":"2020","journal-title":"Front. Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e14317","DOI":"10.14814\/phy2.14317","article-title":"In vitro evidence of decompression bubble dynamics and gas exchange on the luminal aspect of blood vessels: implications for size distribution of venous bubbles","volume":"7","author":"Arieli","year":"","journal-title":"Physiol. Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.resp.2018.08.010","article-title":"Taravana, vestibular decompression illness, and autochthonous distal arterial bubbles","volume":"259","author":"Arieli","year":"","journal-title":"Respir. Physiol. Neurobiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e13191","DOI":"10.14814\/phy2.13191","article-title":"A biophysical vascular bubble model for devising decompression procedures","volume":"5","author":"Arieli","year":"2017","journal-title":"Physiol. Rep."},{"key":"B6","first-page":"123","article-title":"Les accidents neurologiques de plong\u00e9e libre au cours de la p\u00eache de l\u2019huitre perli\u00e8re dans les \u00eeles Tuamotou. Commentaires \u00e0 propos de 35 cas de \u201cTaravana\u201d","volume":"12","author":"Bagnis","year":"1968","journal-title":"Rev. Intern. Oceanogr. Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1139\/cjpp-2019-0341","article-title":"Vascular dysfunction following breath-hold diving","volume":"98","author":"Barak","year":"2020","journal-title":"Can. J. physiology Pharmacol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1007\/s12028-010-9370-1","article-title":"Prognostic factors of spinal cord decompression sickness in recreational diving: retrospective and multicentric analysis of 279 cases","volume":"15","author":"Blatteau","year":"2011","journal-title":"Neurocrit. Care"},{"key":"B9","first-page":"1068","article-title":"Gas nuclei, their origin and their role in bubble formation","volume":"77","author":"Blatteau","year":"2006","journal-title":"Aviat. Space Environ. Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"31","DOI":"10.28920\/dhm53.1.31-41","article-title":"The risk of decompression illness in breath-hold divers: a systematic review","volume":"53","author":"Blogg","year":"2023","journal-title":"Diving Hyperb. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s00421-019-04296-2","article-title":"Arterial blood gases in divers at surface after prolonged breath-hold","volume":"120","author":"Bosco","year":"2020","journal-title":"Eur. J. Appl. Physiol."},{"key":"B12","first-page":"309","article-title":"Circulating bubbles and breath-hold underwater fishing divers: a two-dimensional echocardiography and continuous wave Doppler study","volume":"24","author":"Boussuges","year":"1997","journal-title":"Undersea Hyperb. Med."},{"key":"B13","first-page":"449","article-title":"Detection of venous gas emboli after repetitive breath-hold dives: case report","volume":"43","author":"Cialoni","year":"2016","journal-title":"Undersea Hyperb. Med."},{"key":"B14","first-page":"205","article-title":"Taravana diving syndrome in the Tuamotu diver","volume-title":"Physiology of breath-hold diving and the Ama of Japan","author":"Cross","year":"1965"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1152\/jappl.1997.83.4.1282","article-title":"Cardiovascular changes during deep breath-hold dives in a pressure chamber","volume":"83","author":"Ferrigno","year":"1997","journal-title":"J. Appl. Physiol."},{"key":"B16","first-page":"83","article-title":"Risk of decompression sickness in extreme human breath-hold diving","volume":"36","author":"Fitz-Clarke","year":"2009","journal-title":"Undersea Hyperb. Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1152\/japplphysiol.00242.2016","article-title":"Comments on viewpoint: why predominantly neurological DCS in breath-hold divers?","volume":"120","author":"Foster","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/S1474-4422(15)00111-8","article-title":"Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions","volume":"14","author":"Fugate","year":"2015","journal-title":"Lancet Neurol."},{"key":"B19","first-page":"971","article-title":"Neurological disorders after repetitive breath-hold diving","volume":"77","author":"Gempp","year":"2006","journal-title":"Aviat. Space Environ. Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.mbs.2015.01.001","article-title":"Decompression sickness in breath-hold diving, and its probable connection to the growth and dissolution of small arterial gas emboli","volume":"262","author":"Goldman","year":"2015","journal-title":"Math. Biosci."},{"key":"B21","first-page":"93","article-title":"Les accidents neurologiques de d\u00e9compression en apn\u00e9e; responsabilit\u00e9 du locoplongeur","volume":"6","author":"Grandjean","year":"1996","journal-title":"Bull. Medsubhyp."},{"key":"B22","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1212\/WNL.0000000000006441","article-title":"Mystery case: white matter lesion related to decompression sickness following extreme breath-hold diving","volume":"91","author":"Guerreiro","year":"2018","journal-title":"Neurology"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2039","DOI":"10.3174\/ajnr.A4005","article-title":"Neuroimaging of diving-related decompression illness: current knowledge and perspectives","volume":"35","author":"Kamtchum Tatuene","year":"2014","journal-title":"AJNR. Am. J. Neuroradiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s00062-014-0293-7","article-title":"Posterior reversible encephalopathy syndrome: the spectrum of MR imaging patterns","volume":"25","author":"Kastrup","year":"2015","journal-title":"Clin. Neuroradiol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1002\/1531-8249(200004)47:4<462::aid-ana9>3.0.co;2-y","article-title":"Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion\/perfusion magnetic resonance imaging","volume":"47","author":"Kidwell","year":"2000","journal-title":"Ann. neurology"},{"key":"B26","doi-asserted-by":"publisher","first-page":"711850","DOI":"10.3389\/fphys.2021.711850","article-title":"Decompression illness in repetitive breath-hold diving: why ischemic lesions involve the brain?","volume":"12","author":"Kohshi","year":"2021","journal-title":"Front. Physiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e105006","DOI":"10.1371\/journal.pone.0105006","article-title":"Brain damage in commercial breath-hold divers","volume":"9","author":"Kohshi","year":"2014","journal-title":"PLoS One"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1080\/02640410903121351","article-title":"Decompression sickness in breath-hold divers: a review","volume":"27","author":"Lema\u00eetre","year":"2009","journal-title":"J. Sports Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.wem.2014.02.002","article-title":"Doppler detection in Ama divers of Japan","volume":"25","author":"Lema\u00eetre","year":"2014","journal-title":"Wilderness Environ. Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1159\/000357169","article-title":"Magnetic resonance imaging in breath-hold divers with cerebral decompression sickness","volume":"6","author":"Matsuo","year":"2014","journal-title":"Case Rep. Neurol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1152\/jappl.1965.20.5.1028","article-title":"Decompression sickness following repeated breath-hold dives","volume":"20","author":"Paulev","year":"1965","journal-title":"J. Appl. Physiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2592","DOI":"10.1152\/jappl.1992.73.6.2592","article-title":"Nitrogen tensions in brachial vein blood of Korean ama divers","volume":"73","author":"Radermacher","year":"1992","journal-title":"J. Appl. Physiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"964","DOI":"10.3389\/fneur.2019.00964","article-title":"Imaging of atypical and complicated posterior reversible encephalopathy syndrome","volume":"10","author":"Saad","year":"2019","journal-title":"Front. Neurol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.3390\/tomography8030096","article-title":"Breath-hold diving-related decompression sickness with brain involvement: from neuroimaging to pathophysiology","volume":"8","author":"S\u00e1nchez-Villalobos","year":"2022","journal-title":"Tomogr. Ann. Arbor. Mich."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1152\/japplphysiol.00840.2015","article-title":"Why predominantly neurological decompression sickness in breath-hold divers?","volume":"120","author":"Schipke","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1172646","DOI":"10.3389\/fmed.2023.1172646","article-title":"Therapeutic management of severe spinal cord decompression sickness in a hyperbaric center","volume":"10","author":"Simonnet","year":"2023","journal-title":"Front. Med."},{"key":"B37","first-page":"355","article-title":"Venous gas emboli following repeated breathhold dives","volume":"31","author":"Spencer","year":"1972","journal-title":"Fed. Proc."},{"key":"B38","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jns.2019.07.018","article-title":"Posterior reversible encephalopathy syndrome: a review with emphasis on neuroimaging characteristics","volume":"404","author":"Tetsuka","year":"2019","journal-title":"J. Neurol. Sci."},{"key":"B39","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1123\/ijspp.2016-0042","article-title":"Risk of neurological insult in competitive deep breath-hold diving","volume":"12","author":"Tetzlaff","year":"2016","journal-title":"Int. J. Sports Physiol. Perform."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2024.1478650\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T04:43:09Z","timestamp":1727152989000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2024.1478650\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,24]]},"references-count":39,"alternative-id":["10.3389\/fphys.2024.1478650"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2024.1478650","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,24]]},"article-number":"1478650"}}