Fig. 1.

Performing a prolonged Valsalva maneuver during extended underwater swimming induced intracerebral hemorrhages on two separate occasions. CT (A) versus T2*-GRE MRI (B) showing left hemispheric hemorrhage (arrow) at the time of initial admission in 2015 after first Valsalva maneuver-related incident during underwater swimming. CT (C) versus T2*-GRE MRI (D) showing right hemispheric acute bleed (arrow) and left hemispheric subacute bleed (star) at the time of second admission in 2017 after two Valsalva maneuvers performed during underwater swimming separated by about 2 weeks. Note that the CT and MRI images have different imaging angles. MR images were obtained on a 1.5 T field strength scanner (GE medical systems)