Q; 32 year old otherwise healthy male admitted to ICU with paraplegia. Patient reports acute back pain during his recent vacation to Miami beach followed by progressive numbness and weakness. Patient denies any drug abuse, sexual encounter, or animal/insect bite/envenomation. MRI showed restricted diffusion in the lower thoracic spinal cord to the conus medullaris. What could be the diagnosis?
Answer: Surfers' myelopathy
Interestingly surfer's myelopathy often occurs in young people after first time surfing without any known trauma. Clinically progressive lower extremity numbness and weakness is described preceded by acute lower back pain. The cause is not clear but it is speculated that lying prone on the surfboard (lumbar hyperextension) for prolonged periods of time causes the vascular compression leading to eventual myelopathy. MRI shows restricted diffusion in the lower thoracic spinal cord to the conus medullaris. Unfortunately, recovery is not guaranteed.
#neurology
References:
1. Chang CW, Donovan DJ, Liem LK, et al. Surfers' myelopathy: a case series of 19 novice surfers with nontraumatic myelopathy. Neurology 2012; 79:2171.
2. Lieske J, Cameron B, Drinkwine B, et al. Surfer's myelopathy-demonstrated by diffusion-weighted magnetic resonance imaging: a case report and literature review. J Comput Assist Tomogr 2011; 35:492.
3. Takakura T, Yokoyama O, Sakuma F, et al. Complete paraplegia resulting from surfer's myelopathy. Am J Phys Med Rehabil 2013; 92:833.
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