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Arai K, Ishizuka K, Nakai M. Surfers' myelopathy. Eur J Intern Med 2024:S0953-6205(24)00223-1. [PMID: 38772828 DOI: 10.1016/j.ejim.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Kento Arai
- Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan.
| | - Mori Nakai
- Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
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Tong AN, Zhang JW, Tang HH, Meng YF, Liu SJ, Lv Z, Chen SZ, Liu JS, Bai JZ, Wang FY, Hong Y. Clinical characteristics of pediatric traumatic spinal cord injury in China: A single center retrospective study. J Spinal Cord Med 2024; 47:148-154. [PMID: 35830536 PMCID: PMC10795585 DOI: 10.1080/10790268.2022.2087139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To investigate the clinical characteristics of children with traumatic spinal cord injury (SCI) admitted to a research rehabilitation center between 2011 and 2020, with a view to generate crucial data for understanding and prevention of pediatric traumatic SCI. DESIGN Retrospective cohort study. SETTING The National Rehabilitation Research Center of China, Beijing, China. PARTICIPANTS Medical records and imaging data of children with traumatic SCI admitted to the rehabilitation research center from 2011 to 2020. INTERVENTIONS Not applicable. OUTCOME MEASURES Data on age, sex, cause of injury, neurological level of injury, impairment scale of SCI and details of spine fracture or dislocation were all collected and analyzed. RESULTS A total of 351 patients were included in the study, including 133 males (37.9%) and 218 females (62.1%). There were 231 cases (65.8%) without spine fracture or dislocation. SCI without fracture or dislocation (SCIWORA) was the most common in children between the age of 5 and 14 years (77.9%), and injuries caused by sports were the most common in girls (90.8%). Among sports injuries, those due to a special dance movement called "Xia-Yao" in Chinese, which involves hyperextension of the trunk, constituted the majority, with the neurological level of injuries located predominantly in the middle (34.6%) and lower (44.2%) thoracic levels. CONCLUSION Girls between the ages of 5 and 14 years constituted the majority of SCIWORA injuries at the thoracic levels, which were caused mainly by "Xia-Yao". Overall, careful attention should be paid to prevent this kind of injury in children.
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Affiliation(s)
- An-Ni Tong
- Department of Rehabilitation Medicine, Beijing Haidian Section of Peking University Third Hospital: Beijing Haidian Hospital, CHINA, Beijing
| | - Jun-Wei Zhang
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - He-Hu Tang
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - Yu-Fei Meng
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - Shu-Jia Liu
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - Zhen Lv
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | | | | | - Jin-Zhu Bai
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - Fang-Yong Wang
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
| | - Yi Hong
- China Rehabilitation Research Center, CHINA
- School of Rehabilitation Medicine, Capital Medical University, CHINA
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Zeng L, Wang YL, Shen XT, Zhang ZC, Huang GX, Alshorman J, Serebour TB, Tator CH, Sun TS, Zhang YZ, Guo XD. Guidelines for management of pediatric acute hyperextension spinal cord injury. Chin J Traumatol 2023; 26:2-7. [PMID: 36137934 PMCID: PMC9912180 DOI: 10.1016/j.cjtee.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/21/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.
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Affiliation(s)
- Lian Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Long Wang
- Department of Orthopedics, Wuhan No. 1 Hospital, Wuhan Integrated TCM & Western Medicine Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Tao Shen
- Department of Pediatric Orthopaedic Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Zhi-Cheng Zhang
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Gui-Xiong Huang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jamal Alshorman
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tracy Boakye Serebour
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Charles H. Tator
- Toronto Western Research Institute, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Tian-Sheng Sun
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China,Corresponding author. suntiansheng-@163.cm
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
| | - Xiao-Dong Guo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Cleaver J, Boehm M, Faulkner H. Acute paraparesis during surfing: the perils of riding the wave. Clin Med (Lond) 2022; 22:475-477. [PMID: 38589070 PMCID: PMC9595011 DOI: 10.7861/clinmed.2022-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jonathan Cleaver
- Gloucestershire Royal Hospital, Gloucester, UK and Southmead Hospital, Bristol, UK.
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Wang Y, Zeng L, Zhu F, Huang G, Wan Y, Yao S, Chen K, Guo X. Acute hyperextension myelopathy in children: Radiographic predictors of clinical improvement. Spinal Cord 2022; 60:498-503. [PMID: 35046538 DOI: 10.1038/s41393-021-00739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 01/10/2023]
Abstract
STUDY DESIGN Retrospective case series SETTING: Three hospitals in China. OBJECTIVE Previous research indicates that only neurological status on admission determines prognosis of acute hyperextension myelopathy (AHM). The object of this study is to analyze other unfavorable predictors of AHM in children. METHODS The clinical data of children with AHM were retrospectively analyzed. The ASIA impairment scale (AIS) grade was recorded upon admission and at last follow-up. Intramedullary lesion length (IMLL) was measured in the sagittal T2-weighted imaging (T2WI) within two weeks after onset; gadolinium enhancement in the cord was recorded for each patient. Relationships among AIS grade, IMLL, gadolinium enhancement in the cord, and clinical improvement were assessed. RESULTS A total of 33 patients were included in this retrospective study. IMLL between complete and incomplete injury was significantly different (p < 0.01) in the subacute stage, and no difference was observed in the acute stage. Correlation analysis revealed that AIS grade on admission (r = 0.906, p < 0.001) was significantly positively correlated with clinical improvement. IMLL (r = -0.608, p < 0.001) and abnormal gadolinium enhancement (r = -0.816, p < 0.001) in the cord in the subacute stage were significantly negatively correlated with clinical improvement. There were no associations between IMLL in the acute stage and clinical improvement (r = -0.248, p = 0.242). The statistically significant predictors of clinical improvement were AIS grade on admission, IMLL in the subacute stage, and abnormal gadolinium enhancement. CONCLUSION IMLL in the subacute stage and abnormal gadolinium enhancement in the cord are two other prognostic predictors of AHM in children.
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Affiliation(s)
- Yulong Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lian Zeng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fengzhao Zhu
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Guixiong Huang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yizhou Wan
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sheng Yao
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Kaifang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaodong Guo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Loh YL, Atresh S, Ferguson K. Acute flaccid paralysis of a new surfer: A case report. Medicine (Baltimore) 2022; 101:e29188. [PMID: 35482988 PMCID: PMC9276152 DOI: 10.1097/md.0000000000029188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Surfer's myelopathy is a rare atraumatic spinal cord injury most frequently experienced by novice surfers. Patients often experience back pain, followed by motor, sensory, bowel, and bladder involvement. Here, we report a case of surfer's myelopathy. PATIENT CONCERNS The patient presented with acute low back pain associated with lower limb weakness, sensory loss, urinary retention, and perineal paraesthesia 1 hour after her first surf lesson. DIAGNOSIS On arrival at the emergency department, she was noted to have flaccid paralysis with flickers in both lower limbs, reduced sensation in the midthoracic region, reduced anal tone, and saddle anesthesia. Magnetic resonance imaging of the spine revealed evidence of restricted diffusion from T6 to the level of the conus. Extensive investigations, including cerebrospinal fluid analysis, vasculitides/paraneoplastic screening, and further imaging, were unremarkable. She was diagnosed with complete T7 spinal cord injury secondary to surfer's myelopathy. INTERVENTIONS She subsequently received methylprednisolone and was transferred to the spinal injury unit for rehabilitation. As she experienced persistent neuropathic pain at the level of the injury, she received input from the local pain team. One month after the injury, the patient developed swelling of the right thigh associated with reduced internal and external rotation of the right hip, impacting rehabilitation. The patient was diagnosed with heterotopic ossification following a triple-phase bone scan. She then received intravenous zolendronic acid, which had a good effect. OUTCOMES Four months after the initial presentation, she was discharged to the community. Despite no improvement in her neurological status, she was independent of transfers and mobility with a wheelchair. In addition, she managed her neurogenic bowel and bladder independently with intermittent self-catheterization and a transanal irrigation system. At 6 months, she engaged well with returning to drive program and vocational rehabilitation. LESSONS Neurological recovery from surfer's myelopathy has been shown to vary from complete recovery to minimal recovery. With a spinal-specific rehabilitation program, this patient remains independent of her activities of daily living. Surfer's myelopathy often occurs in inexperienced surfers; therefore, it is crucial to provide education to surfers and instructors.
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Abstract
Acute myelopathies are spinal cord disorders characterized by a rapidly progressive course reaching nadir within hours to a few weeks that may result in severe disability. The multitude of underlying etiologies, complexities in confirming the diagnosis, and often unforgiving nature of spinal cord damage have always represented a challenge. Moreover, certain slowly progressive myelopathies may present acutely or show abrupt worsening in specific settings and thus further complicate the diagnostic workup. Awareness of the clinical and magnetic resonance imaging characteristics of different myelopathies and the specific settings where they occur is fundamental for a correct diagnosis. Neuroimaging helps distinguish compressive etiologies that may require urgent surgery from intrinsic etiologies that generally require medical treatment. Differentiation between various myelopathies is essential to establish timely and appropriate treatment and avoid harm from unnecessary procedures. This article reviews the contemporary spectrum of acute myelopathy etiologies and provides guidance for diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Lim J, Hamouda ES, Fortier MV, Thomas T. Antecedent Minor Trauma and Hyperacute Presentations in Childhood Transverse Myelitis. J Child Neurol 2021; 36:1034-1041. [PMID: 34353149 DOI: 10.1177/08830738211025856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Fibrocartilaginous embolism and spinal cord infarction may resemble transverse myelitis with antecedent minor trauma (sporting activity or minor falls) or with hyperacute (<12-hour) presentation. METHODS Diagnostic criteria for fibrocartilaginous embolism and spinal cord infarction were applied to a 10-year (2007-2016) cohort of children aged 1 month to 16 years with transverse myelitis and clinical, laboratory, neuroimaging, and outcome data compared between those with and without antecedent minor trauma. RESULTS Thirty-two children of median age 8.9 (range 2.7-15.8) years were included; 19 (59%) were female. Falls at home, school, or play (6 children, 60%), swimming (2, 20%), physical education (1, 10%), and caning (1, 10%) were antecedent events in 10 (31%) children. Six (19%) had hyperacute presentations. One patient met spinal cord infarction criteria; none had fibrocartilaginous embolism. Children with transverse myelitis and antecedent minor trauma had single, short spinal cord lesions (median 3 vertebral bodies) but without a specific neuroimaging lesion pattern. None had intervertebral disc abnormalities or brain involvement and were negative for myelin oligodendrocyte and aquaporin 4 antibodies. Twenty-five (86%) of 29 had cerebrospinal fluid inflammation, and 30 (94%) received immunotherapy. Thirty (97%) were followed for a median of 3.6 (0.1-10.2) years, with good outcome (modified Rankin Scale score 0-1) in the majority (80%). Four (75%) with hyperacute presentation had a good outcome (modified Rankin Scale score 0-1), but the patient with spinal cord infarction was the most disabled (modified Rankin Scale score 4). CONCLUSION Minor trauma or hyperacute presentations does not always indicate fibrocartilaginous embolism or spinal cord infarction. Children with minor trauma preceding transverse myelitis have a distinct clinicoradiologic syndrome, with good outcome following immunotherapy.
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Affiliation(s)
- Jocelyn Lim
- Neurology Service, Department of Paediatric Medicine, 37579KK Women's and Children's Hospital, Singapore
| | - Ehab Shaban Hamouda
- Department of Radiology, Children and Adolescent Services, 200462Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Marielle Valerie Fortier
- Department of Diagnostic & Interventional Imaging, 37579KK Women's and Children's Hospital, Singapore
| | - Terrence Thomas
- Neurology Service, Department of Paediatric Medicine, 37579KK Women's and Children's Hospital, Singapore
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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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Yang SY, Lee JM. Golfer's Myelopathy: Is It Like Surfer's Myelopathy? Ann Indian Acad Neurol 2021; 23:714-715. [PMID: 33623283 PMCID: PMC7887472 DOI: 10.4103/aian.aian_266_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/21/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seok-Yeol Yang
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Jong-Mok Lee
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
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Bouattour N, Farhat N, Sakka S, Hdiji O, Daoud S, Moalla K, Damak M, Mhiri C. An unusual case of acute myelopathy: Surfer's myelopathy in a teenage gymnast. Rev Neurol (Paris) 2021; 177:717-719. [PMID: 33478736 DOI: 10.1016/j.neurol.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- N Bouattour
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia.
| | - N Farhat
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - S Sakka
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - O Hdiji
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - S Daoud
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - K Moalla
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - M Damak
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
| | - C Mhiri
- Neurology's Department, Habib Bourguiba Hospital, Ferdaous Street, 3029 Sfax, Tunisia
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12
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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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14
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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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15
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Ischemic damage may play an important role in spinal cord injury during dancing. Spinal Cord 2020; 58:1310-1316. [PMID: 32561846 PMCID: PMC7708299 DOI: 10.1038/s41393-020-0503-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective analysis. SETTING China Rehabilitation Research Center, Beijing, China. OBJECTIVE To explore possible mechanisms underlying spinal cord injury (SCI) in children caused by hyperextension of the spine while dancing. METHODS The clinical records of 88 children with SCI (mean age, 5.97 years; age range, 4-10 years) admitted to our hospital from January 1989 to October 2019 were retrospectively reviewed. Computed tomography and magnetic resonance imaging were performed on the day of injury. The time from injury to development of paralysis, as well as post-injury activities were surveyed, while abnormal patterns on images, the range of the involved vertebrae, and the extents of edema and atrophy were assessed. RESULTS Among the 88 patients, 6 (6.8%) were unable to move immediately after SCI, while paralysis occurred in 42, 23, and 17 patients at <30, 30-60, and >60 min after SCI, respectively. The neurological level of injury of 84 patients was between T4 and T12. On sagittal T2-weighted images (T2WIs), the longitudinal range of spinal cord edema was more than one vertebral body in 65 patients, while spinal cord atrophy below T8 was found in 40 patients. On axial T2WIs, although three patients had none, long T2 signals were found in the central gray matter of seven patients. Meanwhile, necrosis of the central area combined with the peripheral white matter was observed in 57 patients, while three patients had total involvement on a cross section. CONCLUSION Ischemia-related damage, rather than direct trauma to the spinal cord, may play an important role in SCI due to spinal hyperextension during dancing.
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16
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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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17
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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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18
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Nakano H, Yamamoto D, Yamagami H, Sekine I, Ofuchi H. Paraplesia after surfing in a young female novice surfer: a case report on surfer's myelopathy. Acute Med Surg 2019; 6:312-315. [PMID: 31304036 PMCID: PMC6603321 DOI: 10.1002/ams2.416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/13/2019] [Indexed: 11/08/2022] Open
Abstract
Background Surfer's myelopathy is a non‐traumatic spinal cord injury that was first described in a publication in 2004. However, most emergency physicians are not familiar with this rare disease. Case Presentation The patient was a 19‐year‐old female novice surfer. She had experienced back discomfort without trauma during her surfing lessons. The discomfort turned to dysesthesia of both legs. She could not walk after 1 h and was brought to our hospital. Physical examination revealed weakness and dysesthesia of both legs, absent deep tendon reflexes, bilaterally positive Babinski reflex, and bladder and rectal disturbance. Spine magnetic resonance imaging revealed T2 prolongation from T7 to the medullary cone. She was diagnosed with surfer's myelopathy and treated conservatively. She recovered well and was discharged on day 28. Conclusion Emergency physicians must be better informed about surfer's myelopathy. Novice surfers and instructors should be educated on the early signs and symptoms of this condition.
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Affiliation(s)
- Hidehiko Nakano
- Emergency Department Shonan Kamakura General Hospital Kamakura Kanagawa Japan
| | - Daisuke Yamamoto
- Department of Neurology Shonan Kamakura General Hospital Kamakura Kanagawa Japan
| | - Hiroshi Yamagami
- Emergency Department Shonan Kamakura General Hospital Kamakura Kanagawa Japan
| | - Ichiro Sekine
- Emergency Department Shonan Kamakura General Hospital Kamakura Kanagawa Japan.,Department of Neurology Shonan Kamakura General Hospital Kamakura Kanagawa Japan
| | - Hisashi Ofuchi
- Emergency Department Shonan Kamakura General Hospital Kamakura Kanagawa Japan
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19
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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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20
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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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21
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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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22
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Nasr DM, Rabinstein A. Spinal Cord Infarcts: Risk Factors, Management, and Prognosis. Curr Treat Options Neurol 2017; 19:28. [PMID: 28688063 DOI: 10.1007/s11940-017-0464-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT There are no standard guidelines for treatment of spinal cord ischemia due to how rare it is and the diverse etiology and presentations involved. In addition, to date, there have been no large clinical trials examining ideal pharmacologic treatment options for spinal cord infarct. In our practice, we rely on hemodynamic augmentation initiated as soon as possible. Otherwise, treatment is usually geared towards the etiology of spinal cord ischemia. For instance, spinal cord ischemia occurring after aortic aneurysmal repair may improve with CSF drainage through a lumbar catheter in the periprocedural setting. Vertebral artery dissection should be treated with antithrombotics. If no clear etiology is found and there is evidence of atherosclerosis in other vascular beds, then management is focused on risk factor modification with blood pressure and glucose control, statins, and antithrombotics.
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Affiliation(s)
- Deena M Nasr
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Alejandro Rabinstein
- Division of Critical Care Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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23
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Swinney C, Flick D, Cheng M. Atraumatic Spinal Cord Injury in the Novice Surfer: A Comprehensive Review and Update. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2017; 76:43-47. [PMID: 28210528 PMCID: PMC5304427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Novice surfers are at risk for a rare but potentially devastating form of atraumatic myelopathy. There are 16 published studies on this condition, including 66 cases. The most common suggested mechanism of injury is static hyperextension. However, active mechanisms, in contrast to static, have also been proposed and may be contributory. First time surfers, defined as those who have never been on a surfboard prior to the day of injury, are at particular risk. These individuals make up 89.5%-100% of the reported novice surfers found in the various reports. Multiple neurologic deficits occur and often include paraparesis, paraplegia, urinary retention, and hyperesthesia. While these deficits resolve in some cases, there are reports of multiple instances of permanent injury. Increased awareness of this condition is arguably the most effective preventative measure, as it may lead to avoidance of the predisposing postures. It may also lead to earlier diagnosis in the acute setting, which will become relevant as treatment modalities continue to be refined.
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Affiliation(s)
| | - David Flick
- University of Hawai'i, School of Medicine, Honolulu, HI (CS)
| | - Moses Cheng
- University of Hawai'i, School of Medicine, Honolulu, HI (CS)
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24
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Falconi A, Flick D, Ferguson J, Glorioso JE. Spinal Cord Injuries in Wave-Riding Sports: The Influence of Environmental and Sport-Specific Factors. Curr Sports Med Rep 2016; 15:116-20. [PMID: 26963021 DOI: 10.1249/jsr.0000000000000246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Spinal cord injury is a nonfatal, catastrophic consequence of wave-riding sports. With surfing at the core, a multitude of activities have evolved that attempt to harness the power of ocean waves. The unique qualities of each wave-riding sport, in combination with the environmental factors of the ocean, define the risk for potential injuries. As wave-riding sports have become more advanced, athletes continue to push physical barriers. Taller waves are attempted while incorporating aerial maneuvers, all without protective equipment.
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Affiliation(s)
- Audrey Falconi
- Department of Family Medicine, Tripler Army Medical Center, Honolulu, HI
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25
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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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Ramalho J, Nunes RH, da Rocha AJ, Castillo M. Toxic and Metabolic Myelopathies. Semin Ultrasound CT MR 2016; 37:448-65. [PMID: 27616316 DOI: 10.1053/j.sult.2016.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Joana Ramalho
- Radiology Department, University of North Carolina Hospital, Chapel Hill, NC; Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
| | - Renato Hoffmann Nunes
- Radiology Department, University of North Carolina Hospital, Chapel Hill, NC; Neuroradiology Division, Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
| | | | - Mauricio Castillo
- Radiology Department, University of North Carolina Hospital, Chapel Hill, NC
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Abstract
Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure.
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Affiliation(s)
- Andrew Thomas Gomez
- Family Medicine, University of Washington, 331 Northeast Thornton Place, Box 358372, Seattle, WA 98125, USA
| | - Ashwin Rao
- Primary Care Sports Medicine Fellowship, Sports Medicine Section, Family Medicine, University of Washington, 3800 Montlake Boulevard, Box 354060, Seattle, WA 98195, USA.
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29
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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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30
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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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