The incident of DCI is low, 0.324 per 10,000 person-dives was reported by scientific diving community, while commercial decompression diving has been reported to be higher, as high as 35.3 per 10,000 person-dive [4]. The incident depends highly on the dept of dive operations. Decompression illness (DCI) is a term used to described injuries due to Arterial Gas Embolism (AGE) and Decompression Sickness (DCS).  AGE typically results from pulmonary barotrauma-induced damage to the alveolar wall and introduction of gas into the systemic arterial circulation. DCS results from the uncontrolled release of gas from tissues during or after surfacing with inadequate time for equilibration (decompression) [5,6]. One common classification system of DCS was described as type 1 or type 2. Type 1 DCS is usually characterized by musculoskeletal pain and mild cutaneous symptoms. Skin manifestations include itching and mild rashes, Musculoskeletal manifestations of type 1 DCS are articular or periarticular pain.  Common locations include shoulders, elbows, wrists, hips, knees, and ankles. Type 2 symptoms are more serious. They typically fall into 3 categories: neurologic, inner ear, and cardiopulmonary.  Neurologic symptoms include numbness; paresthesia or tingling; muscle weakness; impaired gait, physical coordination or bladder control; paralysis; or change in mental status. Inner ear symptoms include tinnitus, hearing loss, vertigo or dizziness, nausea, vomiting, and impaired balance. Cardiopulmonary symptoms, known as the chokes, include a dry cough, retrosternal pain, dyspnea, and sometimes pink-stained, frothy sputum.  Severe neurologic DCS symptoms usually appear within 10 minutes of surfacing and in 90% of cases symptoms will be present within the first 3 hours. In some cases, it can take up to 24 hours for symptoms to be noticed by the diver [7-9]. The reporting case should be classified as neurologic Type2.

The clinical assessment is important for diagnosis of DCI. Onset of symptoms less than 10 minutes after surfacing could indicate AGE. Onset of symptoms more than 10 minutes after surfacing are more likely associated with DCS [10]. Depth-time exposure, ascent rate, ascent stops and patterns of repetitive dives are also important factors affecting DCI [11]. Being warm during the descent and/or bottom phase of a dive will increase inert gas uptake, increasing the subsequent decompression stress. Being cold during the ascent and/or stop phase inhibits inert gas elimination, increasing the decompression stress.  Exercise during the descent and/or bottom phase of a dive will increase inert gas uptake, increasing the subsequent decompression stress. Light exercise during the ascent and/or stop phase promotes inert gas elimination, reducing the decompression stress. Health history and medical usage are contributing factors [12]. However, there are no specific diagnostic investigations that can establish the diagnosis of DCS. Chest radiographs are utilized to exclude pneumothorax and pneumomediastinum in cases in which pulmonary barotrauma is suspected. An untreated pneumothorax is a contraindication for recompression in a hyperbaric chamber. It may also be crucial to recognize and treat a pneumothorax before any medical evacuation to the hyperbaric center [13].

High partial pressure oxygen is the primary first aid measure for DCI. High oxygen concentration in the lungs will accelerate inert gas elimination. High oxygen partial pressure in the bloodstream can also alleviate ischemic insults produced by bubble blockages. Sustained oxygen delivery can reduce or even eliminate symptoms [14]. The definitive treatment of DCI is Hyperbaric Oxygen Therapy (HBOT), the delivery of oxygen at a partial pressure substantially higher than that achievable at normal atmospheric pressure. The course of HBOT will vary according to the particulars of each case. Full resolution of DCS symptoms can often be achieved with 1 or sometimes multiple HBOT treatments. In some cases, resolution will be incomplete, even after many treatments. The normal clinical approach is to continue treatments until no further improvement is seen in the patient’s symptoms. Modest residual symptoms will then often resolve slowly, after the treatment series is ended. Full resolution of symptoms can sometimes take months to achieve and in some instances may never be realized [15].

Spinal atrophy could be commonly seen in demyelinating spinal diseases, such as Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder (NMOSD). The atrophy pattern of these diseases is not the same.  Computer-aided artificial intelligent using the pipeline efficiently quantifies the SC volume of MRI images and can be utilized as an affordable tool for diagnostic purposes [16]. However, the side effect of spinal atrophy induced by DCI has not been reported before. It has not been confirmed that DCI will develop spinal atrophy or not, this case report is considered to be one of the evident that hypoxia induced spinal atrophy is possible. However, larger case collection is demanded.