- frequently after nonspecificviral infection – direct viral invasion into cord or autoimmune mechanisms.
Pathology - inflammatory demyelination which involves several segments (usually thoracic).
may progress to necrosis and cavitation.
- lost all motor & sensory functions below level of transverse myelopathy.
N.B. sensory & motor findings tend to be symmetric (vs. MS – asymmetric)!
onset – (sub)acute back pain, ascending leg weakness, paresthesias below level of lesion, sphincter dysfunction.
pathological process may be acute - initially produces spinal shock, but hyperreflexia soon supervenes; persistent areflexic paralysis indicates necrosis over multiple spinal segments (differentiate from Guillain-Barré syndrome).
common additional features:
band of disagreeable dysesthesia above uppermost border of sensory loss.
Freedman, Brett A “Surfer's Myelopathy: A Rare Form of Spinal Cord Infarction in Novice Surfers: A Systematic Review” Neurosurgery: May 2016 - Volume 78 - Issue 5 - p 602–611
rare (64 cases reported), acute, atraumatic thoracic/conus medullaris myelopathy that occurs in young, healthy, novice surfers who have no pre-existent spinal disease.
most definitive support is for a vascularcause (angiogram may show the absence of radicular artery and no artery of Adamkiewicz).
altered venous return that occurs from lying prone for prolonged periods of time on a surfboard can contribute to vascular insufficiency.
occlusion by embolus or vasospasm induced by prolonged hyperextension; there have been no reported cases of a similar acute myelopathy in novice or elite butterfly stroke swimmers, who repetitively and violently hyperextend their flexible trunks for brief periods of time, often while performing a Valsalva maneuver; therefore, it is more likely that prolonged hyperextension plays the putative role.
clinically start with back pain and rapidly progress to complete / incomplete myelopathy.
diagnosis: T2 signal in the central cord within 24-72 hours; gadolinium enhancement and DWI are not helpful; at follow up – cord atrophy at involved levels.
treatment - patients receiving steroids improved 55% of the time; optional – lumbar drain.
incomplete cases improve within 24 hours of onset
no improvement has been reported for ASIA A cases (>50% of reported cases)
overall neurological recovery rate - 42%;
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