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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Alva-Díaz C, Rodriguez-López E, López-Saavedra A, Metcalf T, Morán-Mariños C, Navarro-Flores A, Velásquez-Rimachi V, Aguirre-Quispe W, Shaikh ES, Mori N, Romero-Sanchez R, Pacheco-Barrios K. Is Surfer's myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria. J Neurol 2021; 269:1776-1785. [PMID: 34477933 DOI: 10.1007/s00415-021-10775-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Surfer's myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen. AIM To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy ("Surfer's myelopathy") and propose new diagnostic criteria. METHODS We systematically searched four databases for all observational and case studies on the topic. We performed a narrative synthesis to propose diagnostic criteria and tested the criteria retrospectively on the included cases. A case report is also presented. RESULTS Forty-two articles reporting 104 cases (median age 19 years, slightly male predominance) were included. All cases reported a nontraumatic hyperextension event (58% after surfing). All of the cases presented pain of hyperacute onset. The most frequent clinical feature was bladder or bowel dysfunction (84%). The thoracic region was the most frequently affected (87%) with longitudinal involvement until the conus (67%). At discharge or follow-up, 52% partially recovered. We propose five diagnostic criteria with three levels of certainty (definite, probable, and possible): (1) nontraumatic spine hyperextension activity (in individuals with no pre-existent spinal disease); (2) hyperacute onset (with acute pain onset); (3) spinal cord injury clinic (motor, sensory, or autonomic deficit); (4) MRI findings with central spinal cord abnormalities (multiple segments); and (5) no other alternative diagnosis. We identified 88% definite and 12% probable/possible cases. CONCLUSION The acute hyperextension-induced myelopathy could occur not only during surfing but also during other activities. Therefore, increased awareness and education among sports communities and general physicians are needed.
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Affiliation(s)
- Carlos Alva-Díaz
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Ethel Rodriguez-López
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
| | - Angélica López-Saavedra
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
| | - Tatiana Metcalf
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
| | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Perú
| | | | - Victor Velásquez-Rimachi
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
| | - Wilfor Aguirre-Quispe
- Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Perú
- Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Emad S Shaikh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicanor Mori
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Roberto Romero-Sanchez
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, 550 La Fontana Avenue, La Molina, 15024, Lima, Perú.
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Bickley RJ, Belyea CM, Harpstrite JK, Min KS. Surfing Injuries: A Review for the Orthopaedic Surgeon. JBJS Rev 2021; 9:01874474-202104000-00005. [PMID: 33819199 DOI: 10.2106/jbjs.rvw.20.00152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
» Surfing is safe: the risk of injury ranges from 0.26 to 0.90 injuries per surfer per year, 0.06 to 3.5 injuries per 1,000 days of surfing, and 1.1 to 13.0 injuries per 1,000 hours of surfing. » The most common acute surfing injuries are lacerations, contusions, and sprains; the head and the neck as well as the lower extremities are the locations that are affected most. » The most common mechanism of injury is striking a surfer's own board or that of another surfer. » A pathology that is unique to surfers is surfer's myelopathy; bites and/or stings by sea life and infections caused by marine life also occur in surfers.
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Affiliation(s)
- Ryan J Bickley
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Christopher M Belyea
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - J Kimo Harpstrite
- Department of Orthopaedic Surgery, University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawaii
| | - Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
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Hanchard S, Duncan A, Furness J, Simas V, Climstein M, Kemp-Smith K. Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review. Sports (Basel) 2021; 9:23. [PMID: 33572826 PMCID: PMC7911480 DOI: 10.3390/sports9020023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
The majority of the previous literature investigating injuries in surfing have focused on acute or traumatic injuries. This systematic review appears to be the first to investigate the literature reporting on chronic and gradual-onset injuries and conditions in surfing populations. A search strategy was implemented on five databases in June 2020 to locate peer-reviewed epidemiological studies on musculoskeletal injuries or non-musculoskeletal conditions in surfing. A modified AXIS Critical Appraisal Tool was used to appraise all included texts. Extracted data included key information relevant to the epidemiology of the injuries and conditions. Twenty journal articles were included with the majority rated as good quality and a substantial agreement between raters (k = 0.724). Spine/back (29.3%), shoulder (22.9%), and head/face/neck (17.5%) were the most frequently reported locations of musculoskeletal injury, whilst the most common mechanism of injury was paddling (37.1%). Exostosis was the most frequently described injury or condition in surfing populations, with the most common grade of severity reported as mild obstruction. The key findings of injury type, location, severity, and mechanism can be used to develop relevant injury management and prevention programs for the surfing population, with an emphasis on chronic or gradual-onset spine/back and shoulder injuries, paddling technique, and education on the development and management of exostosis.
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Affiliation(s)
- Samuel Hanchard
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Ashley Duncan
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - James Furness
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Vini Simas
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Mike Climstein
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
- Clinical Exercise Physiology, School of Health and Human Sciences, Southern Cross University, Bilinga, QLD 4225, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing, Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2006, Australia
| | - Kevin Kemp-Smith
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
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Surfer Myelopathy in Children: A Case Series Study. World Neurosurg 2021; 148:e227-e241. [PMID: 33418121 DOI: 10.1016/j.wneu.2020.12.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The cause of surfer myelopathy remains enigmatic and long-term follow-up outcomes are not well documented. In the present study, the mechanisms underlying surfer myelopathy in children are analyzed and the long-term follow-up outcomes are reported. METHODS Clinical data from 3 institutions were retrospectively analyzed. Patients were assessed using the American Spinal Injury Association Impairment Scale (AIS) on admission and at follow-up. The mechanisms were studied by analyzing patients' medical history, magnetic resonance imaging, and magnetic resonance angiography. The prognosis of long-term follow-up was summarized. RESULTS Thirty-one children were diagnosed with surfer myelopathy. Intramedullary high-intensity T2 signal from mid to lower thoracic level to conus was found during the acute stage. Follow-up magnetic resonance imaging in the subacute stage showed cranial progression of the T2 hyperintensity up to 1-10 vertebral segments, and no neurologic deterioration was found. Intramedullary lesion length between the complete and incomplete injury was significantly different (P < 0.01) in the subacute phase. Flow voids around nerve roots and in the epidural space were detected in 18 patients and 15 patients, respectively, on axial T2-weighted imaging. Enlarged tortuous veins were found in 3 of 6 patients who underwent spinal magnetic resonance angiography, which were discontinuous around nerve root. During long-term follow-up, no patients with AIS grade A recovered, and atrophic cord was observed in the later stage in 14 patients. Patients with incomplete injury had different recoveries. CONCLUSIONS Surfer myelopathy in children is caused by spinal venous hypertension. The AIS grade on admission is a predictor of prognosis.
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Gandhi J, Lee MY, Joshi G, Khan SA. Surfer's myelopathy: A review of etiology, pathogenesis, evaluation, and management. J Spinal Cord Med 2021; 44:2-7. [PMID: 30767718 PMCID: PMC7919899 DOI: 10.1080/10790268.2019.1577057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Context: Surfer's myelopathy (SM) is an acute syndrome identified by nontraumatic paraparesis or paraplegia. Though traditionally tied to first-time surfers, the condition encompasses any activity involving hyperextension of the back such as gymnastics, yoga, and Pilates.Methods: MEDLINE® and Google Scholar literature searches were gathered to identify relevant case reports for determining the etiology, pathogenesis, evaluation, and management of SM.Results: While the rare nature of SM limits its full understanding, studies have pinpointed that hyperextension in the back leads to vasculature insufficiency secondary to dynamic compression of the artery of Adamkiewicz. In surfing, this hyperextension combined with the execution of the Valsalva maneuver while trying to stand up on the surfboard likely increases intraspinal pressure. Due to its nontraumatic origin, the presence of SM is not immediately clear. Moreover, its similarity in clinical and radiological presentations with other entities can further complicate diagnosis. Seemingly, idiopathic urological symptoms can be explained by the physician if they conduct a thorough history.Conclusion: In an effort to raise awareness for the practicing physician, we presently review the etiology, diagnosis, treatment, and prolonged effects of SM. With the surging popularity of surfing as well as the advent of children participating in precarious sports and activities at an earlier age, we can expect a rising incidence of traumatic and nontraumatic spinal cord injuries. Neurologists, urologists, emergency medicine and sports medicine physicians alike can utilize this review to build a high index of suspicion for SM. The risk factors for SM should be conveyed to those participating in novices in surfing, yoga, gymnastics, ballet, and any activity enabling sustained or repeated spinal extension. Increased general awareness will facilitate increased symptom recognition in order to arrest aggravation of injury.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA,Medical Student Research Institute, St. George’s University School of Medicine, St. George, Grenada
| | - Min Yea Lee
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, New York, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, New York, USA,Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York, USA,Correspondence to: Sardar Ali Khan, Department of Urology, Health Sciences Center T9-040, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794-8093, USA; Ph: +1-631-987-0132, Fax: +1-631-444-7620.
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Igasaki S, Suzuki Y, Sakai N, Takenouchi A, Shinohara K, Kanemoto T. [A case of surfer's myelopathy with serial imaging examination from early stage after onset]. Rinsho Shinkeigaku 2020; 60:752-757. [PMID: 33115989 DOI: 10.5692/clinicalneurol.cn-001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Surfer's myelopathy is non-traumatic spinal cord injury which develops in beginner surfers. The patient was a 17-year-old female who developed severe paraplegia with bilateral sensory dysfunction below the groin and bladder/rectal dysfunctions after her first surfing lesson. A spinal-cord MRI performed six hours after onset revealed an intramedullary hyperintensity area from T8 to the conus medullaris on the T2 weighted images. Expansion of this hyperintensity area was observed on Day 3 and showed a reduction on Day 8. After providing intravenous methylpredonisolone, intravenous glycerol and intravenous edaravone, motor function and bladder/rectal functions began to improve after approximately three weeks. In this study, the expansion of the lesion in the early stages of the disease course was observed by sequential spinal MRI. Furthermore, a time lag between improvement according to imaging and improvement in symptoms was also observed.
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Affiliation(s)
| | - Yoji Suzuki
- Department of Neurology, Yaizu City Hospital
| | - Naoki Sakai
- Department of Neurology, Yaizu City Hospital
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Abstract
BACKGROUND Literature regarding surfing injuries is scarce and most studies report a high number of minor injuries. Recent literature suggests that musculoskeletal injuries are more common than previously reported. In the mid 2000s, competitive surfing has seen an increase in aerial maneuvers, as they have become more highly rewarded by the judging panel, which may be contributing to a change in injury patterns. Our goal was to evaluate orthopedic injuries in professional surfers. HYPOTHESIS Orthopedic injuries in professional surfers are diverse and have evolved with skill and technology. STUDY DESIGN Retrospective observational study. LEVEL OF EVIDENCE Level 4 Case Series. METHODS Medical records of professional surfers from a single orthopedic center between 1991 and 2016 were reviewed. Injuries sustained while surfing and chronic injuries related to surfing were included. Site of injury, diagnosis, and treatment were recorded along with demographic data. RESULTS In total, 163 injuries in 86 athletes were recorded. The median injury age was 28.5 years (range 12-62 years) and 92.6% of patients were male. The most frequently injured body parts were the knee (28.2%), ankle (22.1%), and shoulder (19%). Most knee injuries were of the medial collateral ligament at 49%, with 75% of ankle injuries being sprains, and in shoulder, 48% had instability, 42% had a rotator cuff tear, and 35% had a superior anterior-posterior labral tear. Lower extremity injuries primarily affected the surfers' back leg (72.5%). In all, 34.6% of all injuries required surgical intervention and involved shoulder injuries most the time. CONCLUSIONS The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers' rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.
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Gilbert C, Kirshblum S, Miller A, Nieves J. Surfer's myelopathy: an atypical case presentation. Spinal Cord Ser Cases 2020; 6:46. [PMID: 32503991 PMCID: PMC7275076 DOI: 10.1038/s41394-020-0297-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Surfer's myelopathy (SM) is a rare nontraumatic spinal cord injury seen in beginner surfers and people participating in activities involving prolonged lumbar hyperextension. The majority of cases of SM have been reported in younger patients under 40 years of age, with initial magnetic resonance imaging (MRI) showing T2 signal abnormalities. We present a case of SM in a person over 40 years old whose initial MRI did not show the T2 signal abnormalities usually reported in SM. CASE PRESENTATION A 43-year-old male in good physical condition went surfing for the first time and developed generalized back pain that progressed to include bilateral lower extremity pain with numbness and weakness. MRI within 11-12 h of symptom onset revealed no acute T2 signal abnormalities. At the time of initial presentation he had classification consistent with a T12 American Spinal Injury Association Impairment Scale (AIS) A and at rehabilitation discharge, 6 weeks later, he had classification of T12 AIS B. DISCUSSION Not all cases of SM present similarly. As surfing is a popular sport, education on early identification of warning signs is crucial for instructors and trainees, as well as health care providers. Our case highlights the importance of a comprehensive history and physical examination in developing the diagnosis, especially in presentations that are not classic in nature.
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Affiliation(s)
- Courtney Gilbert
- Rutgers New Jersey Medical School, Newark, NJ, USA.
- Kessler Institute for Rehabilitation, West Orange, NJ, USA.
| | - Steven Kirshblum
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Amanda Miller
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
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Hernandez-Gerez E, Fleming IN, Parson SH. A role for spinal cord hypoxia in neurodegeneration. Cell Death Dis 2019; 10:861. [PMID: 31723121 PMCID: PMC6853899 DOI: 10.1038/s41419-019-2104-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/12/2023]
Abstract
The vascular system of the spinal cord is particularly complex and vulnerable. Damage to the main vessels or alterations to the regulation of blood flow will result in a reduction or temporary cessation of blood supply. The resulting tissue hypoxia may be brief: acute, or long lasting: chronic. Damage to the vascular system of the spinal cord will develop after a traumatic event or as a result of pathology. Traumatic events such as road traffic accidents, serious falls and surgical procedures, including aortic cross-clamping, will lead to an immediate cessation of perfusion, the result of which may not be evident for several days, but may have long-term consequences including neurodegeneration. Pathological events such as arterial sclerosis, venous occlusion and spinal cord compression will result in a progressive reduction of blood flow, leading to chronic hypoxia. While in some situations the initial pathology is exclusively vascular, recent research in neurodegenerative disease has drawn attention to concomitant vascular anomalies in disorders, including amyotrophic lateral sclerosis, spinal muscular atrophy and muscular sclerosis. Understanding the role of, and tissue response to, chronic hypoxia is particularly important in these cases, where inherent neural damage exacerbates the vulnerability of the nervous system to stressors including hypoxia.
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Affiliation(s)
- Elena Hernandez-Gerez
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK
| | - Ian N Fleming
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK
| | - Simon H Parson
- Institute of Medical Sciences University of Aberdeen Foresterhill Aberdeen, AB25 2ZD, Scotland, UK.
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Yang MX, Ault MJ. A Paralyzing Vacation: Surfer's Myelopathy. Am J Med 2019; 132:1289-1291. [PMID: 30998918 DOI: 10.1016/j.amjmed.2019.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Michael X Yang
- Procedure Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.
| | - Mark J Ault
- Procedure Center, Department of Medicine, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif
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Choi JH, Ha JK, Kim CH, Park JH. Surfer's Myelopathy : Case Series and Literature Review. J Korean Neurosurg Soc 2018; 61:767-773. [PMID: 30396249 PMCID: PMC6280062 DOI: 10.3340/jkns.2017.0262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/05/2018] [Indexed: 12/11/2022] Open
Abstract
Three male patients diagnosed with surfer’s myelopathy (19–30 years) were admitted to our hospital. All three patients were novice surfers showing a typical clinical course of rapid progression of paraplegia following the onset of back pain. Typical history and magnetic resonance imaging features indicated the diagnosis of surfer’s myelopathy. Two patients received high-dose steroid therapy and the other was treated with induced hypertension. One patient treated with induced hypertension showed almost full recovery; however, two patients who received high-dose steroid therapy remained completely paraplegic and required catheterization for bladder and bowel dysfunction despite months of rehabilitation. Our case series demonstrates the potentially devastating neurological outcome of surfer’s myelopathy; however, early recovery in the initial 24–72 hours of presentation can occur in some patients, which is in accordance with previous reports. Ischemic insult to the spinal cord is thought to play a crucial role in the pathophysiology of surfer’s myelopathy. Treatment recommendations include hydration, induced hypertension, early spinal angiography with intra-arterial intervention, intravenous tissue plasminogen activator, and high-dose steroid therapy; however, there is no standardized treatment option available. Early recovery appears to be important for long-term neurological outcome. Induced hypertension for initial treatment can be helpful for improving spinal cord perfusion; therefore, it is important for early and long-term neurological recovery. Education and awareness are essential for preventing surfer’s myelopathy and avoiding further deterioration of neurological function.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Ki Ha
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Chung Hwan Kim
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Surfer’s myelopathy: A rare presentation in a teenage gymnast and review of the literature. J Clin Neurosci 2018; 50:157-160. [DOI: 10.1016/j.jocn.2018.01.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/08/2018] [Indexed: 12/19/2022]
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Green E, Zishan US, Robertson N, Papanikitas J, Yanny S, Hughes R, McKean D. Non-traumatic myelopathy associated with prolonged hyperextension during swimming: an unusual variation of Surfer's Myelopathy. Spinal Cord Ser Cases 2018; 4:22. [PMID: 29581889 DOI: 10.1038/s41394-018-0055-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction Surfer's myelopathy (SM) is a rare cause on non-traumatic acute myelopathy. This has classically been described in novice surfers however has been reported in other scenarios. Case presentation We present a case of non-traumatic paraparesis associated with prolonged cervical hyperextension during swimming with imaging characteristics consistent with an unusual variation of SM in a swimmer. Discussion SM and its variants should be considered in the differential diagnosis of any patient presenting with an anterior spinal cord syndrome with a history of either sustained or repeated spinal hyperextension.
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Affiliation(s)
- Edward Green
- 1Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford UK
| | - Umme Sara Zishan
- 2Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Joseph Papanikitas
- 2Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Sarah Yanny
- 2Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Richard Hughes
- 2Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - David McKean
- 2Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Scatchard R, Alves Rosa J, Bowen P, Mortimer A, Sharples PM, Lux AL. A case report: Paediatric surfer's myelopathy. Eur J Paediatr Neurol 2018; 22:199-202. [PMID: 29102345 DOI: 10.1016/j.ejpn.2017.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/19/2017] [Accepted: 09/30/2017] [Indexed: 11/19/2022]
Abstract
Surfer's myelopathy was first described by Thompson et al., in 2004.1 It is a rare cause of sudden spinal cord injury that occurs in the absence of direct trauma to the spinal area in novice healthy surfers. We present the case of the youngest patient we are aware of to be diagnosed with surfer's myelopathy following actual surfing. A clear aetiology for surfer's myelopathy has not previous been described. However, the hypothesis that there is ischaemia to the lower spinal cord is supported by our case, where we present the first clear angiographic evidence of the occlusion of the great anterior radicular artery of Adamkiewicz in a patient diagnosed with surfer's myelopathy.
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Affiliation(s)
- Rebecca Scatchard
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - Joao Alves Rosa
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom; Department of Radiology (Neuroradiology Section), North Bristol NHS Trust, Southmead Hospital, Southmead Way, Bristol BS10 5NB, United Kingdom
| | - Philippa Bowen
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
| | - Alex Mortimer
- Department of Radiology (Neuroradiology Section), North Bristol NHS Trust, Southmead Hospital, Southmead Way, Bristol BS10 5NB, United Kingdom
| | - Peta M Sharples
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
| | - Andrew L Lux
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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Choi J, Seok HY, Kim Y, Kim BJ. Surfer's Myelopathy Mimicking Infectious Myelitis. J Clin Neurol 2017; 13:207-208. [PMID: 28176506 PMCID: PMC5392468 DOI: 10.3988/jcn.2017.13.2.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jongsuk Choi
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Hung Youl Seok
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Yoohwan Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Byung Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea.
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Maharaj MM, Phan K, Hariswamy S, Rao PJ. Surfer's myelopathy: a rare presentation in a non-surfing setting and review of the literature. JOURNAL OF SPINE SURGERY 2016; 2:222-226. [PMID: 27757436 DOI: 10.21037/jss.2016.09.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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. CONCLUSIONS Diagnosis of SM requires a thorough history, clinical examination and imaging (MRI, MRI-DWI). The patient should be admitted early and investigated. The use of rehabilitation services may be useful if available.
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Affiliation(s)
- Monish M Maharaj
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; ; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; ; Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | - Prashanth J Rao
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; ; Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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Wadia S, Padmanabhan P, Moeller K, Rominger A. Pediatric Surfer's Myelopathy. J Emerg Med 2015; 49:e143-5. [DOI: 10.1016/j.jemermed.2015.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
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Imaging features and differentials in surfer’s myelopathy: a case report. Emerg Radiol 2015; 23:89-92. [DOI: 10.1007/s10140-015-1346-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW This article reviews some of the unusual sports-related neurologic disorders within the new and rapidly growing field of sports neurology that neurologists may encounter. RECENT FINDINGS Surfer's myelopathy is a potentially tragic disorder predominantly affecting novice surfers, leaving many who are affected by this condition with permanent paralysis. Neck-tongue syndrome is a rare primary headache disorder that can occur in athletes and nonathletes, and consists of paroxysmal neck and occipital pain and transient ipsilateral tongue numbness, triggered by sudden rotation of the neck. Athletes are also at risk for cervical arterial dissections, with golfers especially prone to vertebral rather than carotid dissections. Finally, "the yips" likely represents a form of occupational dystonia described in golfers. SUMMARY The syndromes described in this article range from relatively minor syndromes that cause discomfort or abnormal movement to potentially devastating cerebrovascular or myelopathic syndromes. Although the disorders described in this article are not common, they can affect individuals involved in sports at all levels, from the novice to the elite athlete, and may present to any neurologist. Neurologists should be aware of the potential for these syndromes to occur as a consequence of athletic activities in order to provide the most appropriate diagnosis, management, and counseling.
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Klontzas ME, Hatzidakis A, Karantanas AH. Imaging findings in a case of stand up paddle surfer's myelopathy. BJR Case Rep 2015; 1:20150004. [PMID: 30363207 PMCID: PMC6159156 DOI: 10.1259/bjrcr.20150004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/08/2015] [Accepted: 02/15/2015] [Indexed: 11/22/2022] Open
Abstract
Stand up paddle (SUP) surfing, a variant of ocean surfing, is becoming very popular because it can be performed at any level of difficulty and thus attracts athletes from a wide range of ages. Unlike ocean surfing, limited data exist on injuries related to SUP surfing. We report the first case of a 28-year-old athlete who developed myelopathy during his first SUP surfing session. Clinical examination revealed severe neurological deficit, which had not subsided fully at the 28-month follow-up.
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Affiliation(s)
- M E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, University of Crete, Heraklion-Crete, Greece
| | - A Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, University of Crete, Heraklion-Crete, Greece
| | - A H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, University of Crete, Heraklion-Crete, Greece
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Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology 2014; 57:241-57. [PMID: 25398656 DOI: 10.1007/s00234-014-1464-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. METHODS In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated. RESULTS Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. CONCLUSION The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany,
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Rehabilitation and Long-Term Course of Nontraumatic Myelopathy Associated with Surfing. Am J Phys Med Rehabil 2013; 92:828-32. [DOI: 10.1097/phm.0b013e318238a1d0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakamoto BK, Siu AM, Hashiba KA, Sinclair BT, Baker BJ, Gerber MS, McMurtray AM, Pearce AM, Pearce JW. Surfer's myelopathy: a radiologic study of 23 cases. AJNR Am J Neuroradiol 2013; 34:2393-8. [PMID: 23828111 DOI: 10.3174/ajnr.a3599] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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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Affiliation(s)
- B K Nakamoto
- Department of Medicine, University of Hawaii, Honolulu, Hawaii
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Dimmick S, Brazier D, Wilson P, Anderson SE. Injuries of the spine sustained whilst surfboard riding. Emerg Radiol 2012. [DOI: 10.1007/s10140-012-1089-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Surfer's myelopathy is a rare, nontraumatic spinal cord injury that typically occurs in beginner surfers. The condition was first described in 2004 by Thompson et al and usually presents in thin young men. We present a 19-year-old man who developed lower back pain, profound bilateral lower limb paraparesis, and hyperesthesia during his first learn to surf class. The event was not associated with trauma. Subsequent magnetic resonance imaging demonstrated features consistent with spinal cord ischemia. The motor recovery due to surfer's myelopathy is variable; our case remained a paraplegic with a T10 sensory level.
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Abstract
Musculoskeletal imaging of the spine can be an invaluable tool to inform clinical decision making in patients with spinal pain. An understanding of the technology involved in producing and interpreting high-resolution images produced from magnetic resonance imaging (MRI) of the human spine is necessary to better appreciate which sequences can be used for, or tailored to, individual patients and their conditions. However, there is substantial variability in the clinical meaningfulness of some MRI findings of spinal tissues. For example, normal variants can often mimic significant musculoskeletal pathology, which could increase the risk of misinformed clinical decisions and, even worse, poor or adverse outcomes. This clinical commentary will highlight some of the pearls and pitfalls of MRI for the cervical, thoracic, and lumbar regions, and include cases to illustrate some of the common imaging artifacts and normal variants for MRI of the spine.
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