Decompression sickness (DCS), also known as "Caisson disease," is a potentially life-threatening condition caused by the formation of inert gas bubbles during rapid decompression, most commonly affecting deep-sea divers. Neurological involvement, particularly spinal cord injury leading to paraplegia, represents one of the most severe manifestations. We report the case of a 44-year-old Filipino male professional diver who developed acute paraplegia following a routine dive. Despite adherence to decompression protocols, he experienced sudden-onset bilateral lower limb weakness during ascent. Initial management included oxygen therapy followed by hyperbaric oxygen therapy, after which he was referred for intensive multidisciplinary rehabilitation within a few days. At presentation, the patient exhibited significant motor weakness with Medical Research Council grading of 2/5 in the left lower limb and 3/5 in the right lower limb, sensory loss below the T8 level, impaired bladder and bowel control, and complete dependence for mobility. Over a period of approximately three months of structured physiotherapy, including conventional therapy, robotic-assisted rehabilitation, neuromuscular stimulation, and gait training, he demonstrated remarkable functional recovery. Muscle strength improved to 4/5, with restoration of independent ambulation, improved sensory function, and regained bladder control. This case highlights the importance of early recognition, prompt hyperbaric therapy, and intensive rehabilitation in achieving near-complete recovery following severe neurological DCS.
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