An Unusual Case of Myelopathy: Surfer's Myelopathy

Dhaliwal, Perry; Cenic, Aleksa; Eesa, Muneer; Plessis, Stephan du

doi:10.1017/s0317167100011616

Cited by 16 publications

(11 citation statements)

References 9 publications

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“…In the setting of surfing this relates to the prone position on the board. This factor was not formerly assessed in our case but has been supported by other studies (6,15). Naturally, this explains why the lower spinal cord and conus medullaris may be vulnerable to arterial insufficiency as evident in the majority of published literature.…”

Section: Discussionsupporting

confidence: 85%

“…Although there have been 64 cases published since 2004, standardisation in the management algorithm of these patients is yet to be achieved (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Several interventions have been proposed, including early steroid therapy and anticoagulation, though the rarity of cases has largely prevented quality research on the matter.…”

Section: Introductionmentioning

confidence: 99%

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Surfer’s myelopathy: a rare presentation in a non-surfing setting and review of the literature

et al. 2016

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Background: Surfers myelopathy can be a rapidly devastating disease and little is known surrounding the pathophysiology of the condition. Although the classical pattern of illness has been well reported, it has never been observed in a non-surfing setting.Methods: A 51-year-old demolition worker presented with acute non-traumatic myelopathy. Clinical examination revealed sensory loss to the level of L2. T2-MRI and MRI-DWI revealed a hyperintense signal suggestive of an ischaemic event. A diagnosis of surfer's myelopathy was made and he was commenced on steroid therapy.Results: Following steroid therapy and fluid management the patient was discharged after 6 days with minor anaethesia but significant overall neurological improvement. Case Report Conclusions: Diagnosis of SM requires a thorough history, clinical examination and imaging (MRI, MRI-DWI IntroductionFirst defined by Thompson et al. [2004], surfer's myelopathy (SM) is a rare diagnosis of acute non-traumatic spinal cord infarction most commonly found in first time surfing patients (1). Postulated to only be driven by the excessive forces applied during surfing, from both manoeuvring and the surrounding waves, the underlying pathophysiology is driven by hyperextension of the spine leading to vascular damage and consequent ischaemia to distal spinal cord segments. The hyperextension itself is believed to increase tension on both the spinal cord and surrounding vasculature, causing possible avulsion of perforating vessels and secondary vasospasm leading to transient ischaemia. This theory has recently been challenged in a recent review by Freedman et al. [2016] suggesting other mechanisms including inferior vena caval compression while surfers lie prone on the board (prolonged valsalva manoeuvre), or embolization in the central/sulcal arteries secondary to spinal disk damage (2).Regardless of etiology, evidence of cord infarction is demonstrable through magnetic resonance imaging (MRI) following presentation, with a classical T2 hyperintensity visible on a longitudinal view. Deterioration is rapid (within hours), with presentation variable including symptoms of back pain, paraplegia, hyperalgesia and non-specific neurological symptoms (3). Similar to presentation, rates of improvement are equally as variable, ranging from no improvement to complete recovery. Lastly, It is important to recognise that the majority of patients are young and generally have no existing spinal or vascular pathology. Hence delayed (>24 hours) presentation may have significant impact on overall outcomes.Although there have been 64 cases published since 2004, standardisation in the management algorithm of The purpose of the present report is (1) to present a possible case of SM involving a non-surfing mechanism and (2) to establish a succinct management algorithm in patients presenting with possible SM. Case presentationA 51-year-old male demolition worker who presented after commencing work with bilateral lower limb paraesthesia and numbness 2 days prior. He reported acute deterior...

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Surfer’s myelopathy: a rare presentation in a non-surfing setting and review of the literature

et al. 2016

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“…Our findings are consistent with previous descriptions of surfer’s myelopathy with the exception that others have also reported sparing of the conus in addition to enhancement of the ventral roots of the cauda equina. 1,4,10 Although T1-weighted noncontrast sequences are usually normal, patchy increased T1-weighted signal changes on initial presentation and repeat imaging 1 month later, presumably from petechial hemorrhage, have rarely been described. 2,6 The T1-weighted signal of the spinal cord was normal in all subjects in our study, and no subject had evidence of intramedullary hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Surfer's Myelopathy: A Radiologic Study of 23 Cases

Nakamoto

Siu

Hashiba

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE Surfing is an uncommon cause of an acute nontraumatic myelopathy. This study describes the MR imaging characteristics and clinical correlates in 23 subjects with surfer’s myelopathy. MATERIALS AND METHODS This was a retrospective review of 23 cases of surfer’s myelopathy from 2003–2012. Spinal cord MR imaging characteristics and neurologic examinations with the use of the American Spinal Injury Association scale were reviewed. Logistic regression was used to determine associations between MR imaging characteristics, American Spinal Injury Association scale, and clinical improvement. RESULTS All subjects (19 male, 4 female; mean age, 26.3 ± 7.4 years) demonstrated “pencil-like,” central T2-hyperintense signal abnormalities in the spinal cord extending from the midthoracic region to the conus with associated cord expansion and varying degrees of conus enlargement on spinal cord MR imaging within 24 hours of symptom onset. T1 signal was normal. Faint gadolinium enhancement was present in a minority. Although there was a strong correlation between initial American Spinal Injury Association score and clinical improvement (P = .0032), MR imaging characteristics were not associated with American Spinal Injury Association score or clinical improvement. CONCLUSIONS Surfer’s myelopathy should be considered in the radiographic differential diagnosis of a longitudinally extensive T2-hyperintense spinal cord lesion. MR imaging characteristics do not appear to be associated with severity on examination or clinical improvement.

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“…14,44,83 While not common, a physical therapist may also encounter patients following acute trauma to the thoracolumbar region. 29,30,67,85,89 Because up to 50% of these patients can have associated neurological involvement, guidelines for using CT and MRI to identify the extent of thoracolumbar fractures and corresponding neurological damage have been explored and developed. 30 Similar to imaging of the CCJ, MRI is capable of detecting ligamentous injury, especially that of the posterior ligamentous complex (PLC)-comprised of the posterior longitudinal ligament, facet joint capsule, ligamentum flavum, and interspinous and supraspinous ligaments-in thoracolumbar burst fractures.…”

mentioning

confidence: 99%