Surfer's Myelopathy-Demonstrated by Diffusion-Weighted Magnetic Resonance Imaging

Lieske, Jonathan; Cameron, Brian M.; Drinkwine, Benjamin; Goretzke, Sean; Alemi, Lily; Needham, Kenneth; Ventura, John M.; Ho, Van Thong; Barge, Donald V. La

doi:10.1097/rct.0b013e31821e277b

Cited by 28 publications

(14 citation statements)

References 12 publications

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“…A few studies have demonstrated increased diffusion restriction on DWI correlating with decreased signal on ADC mapping in surfer’s myelopathy, supporting the hypothesis that the T2-signal abnormalities represent cytotoxic edema in the setting of an acute spinal cord infarction. 8,10 Conventional spinal angiograms were normal when performed in previously described cases. 1,5,10 …”

Section: Discussionmentioning

confidence: 88%

“…Five published papers detailed the time between symptom onset and imaging, and conventional spinal cord MR imaging was abnormal within 2–12 hours. 1,2,4,5,8 One case reported by Kelly and Wright 3 was initially normal but was subsequently abnormal on repeat imaging within 24 hours of the initial MR imaging. 3 DWI with ADC mapping has inconsistently demonstrated restricted diffusion in cases of surfer’s myelopathy.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 88%

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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“…MRI-DWI itself is highly sensitive to detecting acute cellular injury due to the changes in water diffusion present secondary to the ischaemia (11). In both studies in the inclusion of gadolinium contrast did not facilitate diagnosis, but was justified as a means of excluding differentials.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…Twenty-one cases of surfer's myelopathy have been described in the literature [3,[8][9][10][11][12][13][14][15][16]. These people develop progressive bilateral lower limb pain, paresthesia, and paraplegia during their first lesson.…”

Section: Surfer's Myelopathymentioning

confidence: 99%