Surfers’ myelopathy

Chang, Cherylee W.J.; Donovan, Daniel J.; Liem, Leon K.; O’Phelan, Kristine; Green, Deborah; Bassin, Sarice L.; Asai, Susan M.

doi:10.1212/wnl.0b013e31827595cd

Cited by 53 publications

(59 citation statements)

References 19 publications

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“…The largest studies by Nakamoto (n=23) and Chang (n=19) implement routine MRI as the most important diagnostic tool, with the latter showing increased diagnostic accuracy (6/10 patients) associated with the addition of Diffusion weighted imaging (DWI)-consistent with the ischaemic aetiology (4,8). MRI-DWI itself is highly sensitive to detecting acute cellular injury due to the changes in water diffusion present secondary to the ischaemia (11).…”

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%

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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: Discussionmentioning

confidence: 99%

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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“…Arterial insufficiency from hyperextension of the lumbar spine, venous hypertension associated with obstruction of the inferior vena cava by the liver whereas lying in a prone position, fibrocartilaginous embolism caused by retrograde embolism of the nucleus pulpous into the radicular spinal cord arteries, or avulsion of perforating arteries have all been proposed. 81,82 Clinical Presentations Surfer's myelopathy is usually preceded by back discomfort followed by acute myelopathy with variable motor-sensory involvement and urinary incontinence.…”

Section: Pathophysiologymentioning

confidence: 99%

“…81,82 Imaging Findings Surfer's myelopathy is usually associated with a longitudinally extensive T2 hyperintense central cord lesion in the midthoracic region with variable cranial and caudal extension. Patchy increased T1 signal presumably related to petechial hemorrhage have been described.…”

Section: Pathology Findingsmentioning

confidence: 99%

Toxic and Metabolic Myelopathies

Ramalho

Nunes

Rocha

et al. 2016

Seminars in Ultrasound, CT and MRI

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Myelopathy describes any neurologic deficit related to the spinal cord. It is most commonly caused by its compression by neoplasms, degenerative disc disease, trauma, or infection. Less common causes of myelopathy include spinal cord tumors, infection, inflammatory, neurodegenerative, vascular, toxic, and metabolic disorders. Conditions affecting the spinal cord must be recognized as early as possible to prevent progression that may lead to permanent disability. Biopsy is rarely performed, thus the diagnosis and management rely on patient's history, physical examination, laboratory results, and imaging findings. Here we review the clinical presentations, pathophysiological mechanisms, and magnetic resonance imaging findings of myelopathies related to metabolic or toxic etiologies. Semin Ultrasound CT MRI 37:448-465 C 2016 Elsevier Inc. All rights reserved.

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“…Full recovery is expected in patients with AIS B or better, as opposed to patients with AIS A, who typically do not recover. 1 …”

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confidence: 99%

Teaching Neuro Images : Acute neurologic deficits due to surfer's myelopathy

et al. 2016

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A previously healthy 32-year-old man developed acute onset of lower extremity weakness (American Spinal Injury Association [ASIA]-motor L2-S1, grade 2/5), T8 sensory level, and loss of bowel and bladder control (ASIA Impairment Scale [AIS] C) while surfing. The patient was a novice surfer and recalled a prolonged period in prone hyperextension. MRI spine was consistent with surfer's myelopathy, a rare nontraumatic cause of myelopathy found in novice surfers (figure).1,2 The etiology is postulated to be due to dynamic compression of the artery of Adamkiewicz. The patient recovered full function with conservative management over 3 days. Full recovery is expected in patients with AIS B or better, as opposed to patients with AIS A, who typically do not recover. 1 AUTHOR CONTRIBUTIONSJoshua Bakhsheshian: drafting/revising the manuscript for content, including medical writing for content, study concept or design, analysis or interpretation of data. Ki-Eun Chang: acquisition of data, analysis or interpretation of data. Ben A. Strickland: acquisition of data, analysis or interpretation of data. Dan A. Donoho: acquisition of data, analysis or

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Surfers’ myelopathy

Abstract: Although the cause of surfers' myelopathy is unclear, the rapid onset and presence of restricted diffusion suggest ischemic injury. Admission severity appears to be most predictive of neurologic outcome.

Cited by 53 publications

References 19 publications

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

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

Toxic and Metabolic Myelopathies

Teaching Neuro Images : Acute neurologic deficits due to surfer's myelopathy

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