Is Surfer’s myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria

Alva-Díaz, Carlos; Rodriguez-López, Ethel; López-Saavedra, Angélica; Metcalf, Tatiana; Morán‐Mariños, Cristian; Navarro‐Flores, Alba; Velásquez-Rimachi, Victor; Aguirre-Quispe, Wilfor; Shaikh, Emad Salman; Mori, Nicanor; Romero-Sanchez, Roberto; Pacheco‐Barrios, Kevin

doi:10.1007/s00415-021-10775-4

Cited by 5 publications

(9 citation statements)

References 51 publications

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“…Although the cause of surfer’s myelopathy is described as hyperextension in novice surfers, it has also been reported to occur in other cervical extension situations. 9 Similarly, because hyperextension affects the spinal cord, we think that hyperflexion can cause remote thoracic spinal cord injury. In the Concorde position, because the spinal cord is arched by cervical flexion and the body position, spinal hypoperfusion is likely to occur at the most stretched lesion, which would be a lesion of the upper thoracic spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Thoracic spinal cord injury after surgical removal of a ruptured cerebellar arteriovenous malformation in a patient in the Concorde position: illustrative case

Ishikawa,

Endo,

Ohtake

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Thoracic spinal cord injury after posterior cranial fossa surgery in younger patients is a rare complication. There have been reports of this complication in tumor and spine fields but not in vascular surgery. OBSERVATIONS A 22-year-old-man experienced cerebellar arteriovenous malformation rupture, and the malformation was surgically removed with the man in the Concorde position. After surgery, the man had severe paraplegia, and a thoracic spinal cord injury was diagnosed. LESSONS In younger patients, cervical hyperflexion in the Concorde position can cause thoracic spinal cord injury even in surgery for cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Thoracic spinal cord injury after surgical removal of a ruptured cerebellar arteriovenous malformation in a patient in the Concorde position: illustrative case

Ishikawa,

Endo,

Ohtake

et al. 2024

Journal of Neurosurgery: Case Lessons

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“… 23 The pathophysiology may be shared in part with surfer’s myelopathy, a condition that develops in the aftermath of abrupt hyperextension. 24 Intersegmental artery dissection proximal to the artery of Adamkiewicz was reported recently as a cause of spontaneous SCI. 25 The diagnosis required catheter angiography, a procedure that was performed in less than one-fifth of our cohort.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal cord infarction in Austria: a two-center comparative study

Pikija

Kunz

Nardone

et al. 2022

Ther Adv Neurol Disord

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Background: Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded. Objective: To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria. Methods: We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge. Results: We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%). Conclusion: Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.

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“…This tool is composed of eight questions distributed in four domains. Six questions were included, each one rated 1 if considered correct as used in previous studies 17,18 . Because the diseases under study were not focused on adverse effects, the maximum score was 6 and the results were categorized as low (1 and 2), moderate (3 and 4), and high (5 and 6) quality.…”

Section: Methodsmentioning

confidence: 99%

Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports

Pacheco‐Barrios

Navarro‐Flores²,

Melo

et al. 2022

Acta Neuro Scandinavica

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Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis presents commonly with psychiatric symptoms. One cohort of these patients reported that antipsychotic administration led to neuroleptic intolerance (NI) in 19% of them, which was preventable by a prompt encephalitis diagnosis. To date, there is no clear description of the "neuroleptic intolerance" spectrum in general or during anti-NMDAR encephalitis.We aimed to synthesize epidemiological and clinical characteristics of patients with NI and confirmed anti-NMDAR encephalitis, the time to the encephalitis diagnosis, the disease course, outcomes at discharge, and associated factors. We systematically searched three databases, to include clinical cases, case series, and observational studies. Additionally, we reported one clinical case. Results were summarized using narrative synthesis and the quality of the included studies was assessed. We included 22 records representing 40 patients (28 females; mean age, 24.6). Overall, the evidence quality was low. Initially, most cases were admitted in psychiatric wards (70%) with purely psychiatric symptoms (37.5%). However, most of them developed subtle concomitant neurological symptoms. The mean time to anti-NMDAR encephalitis diagnosis was 26.7 days, which was triggered by the NI in six patients. We found no association between clinical variables as delayed diagnosis, admission to psychiatric wards or the presence of malignancy with outcome variables as unfavorable outcomes at discharge, ICU, or mechanical ventilation requirement. A thorough neurological examination in young patients with new-onset psychiatric symptoms could help emergency physicians, neurologists, and psychiatrists suspect anti-NMDAR encephalitis earlier. Awareness of NI as a potential side effect during suspected or confirmed anti-NMDAR encephalitis is encouraged.

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Is Surfer’s myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria

Cited by 5 publications

References 51 publications

Thoracic spinal cord injury after surgical removal of a ruptured cerebellar arteriovenous malformation in a patient in the Concorde position: illustrative case

Thoracic spinal cord injury after surgical removal of a ruptured cerebellar arteriovenous malformation in a patient in the Concorde position: illustrative case

Spontaneous spinal cord infarction in Austria: a two-center comparative study

Neuroleptic intolerance in the context of anti‐N‐methyl‐D‐aspartate receptor encephalitis: A systematic review and synthesis of global case reports

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