A 32 year-old novice surfer with acute onset of low back pain, weakness, numbness, and loss of bowel and bladder control while surfing Teaching NeuroImages.

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A 32 year-old novice surfer with acute onset of low back pain, weakness, numbness, and loss of bowel and bladder control while surfing Teaching NeuroImages Neurology Bakhsheshian et al. © 2016 American Academy of Neurology

Vignette A previously healthy 32 year-old man developed an acute onset of lower back pain, lower extremity weakness and numbness, and loss of bowel and bladder control while surfing The patient was a novice surfer and endorsed a prolonged period of hyperextending in a prone position on his surfboard. Exam was significant for motor strength of L2-S1 being 2/5, Sensory loss from T8 and below, and preserved voluntary anal contraction. Bakhsheshian et al. © 2016 American Academy of Neurology

Imaging Bakhsheshian et al. A B D C T8 LEGEND Surfer’s Myelopathy. A. MRI thoracic spine demonstrates a long segment of increased STIR/T2 signal in the central spinal cord approximately spanning from T7/T8 to the conus. B. Demonstrates the central hyperintensity in the central spinal cord at T8 and at C. T12. D. MRI lumbar spine was negative for compressive pathologies. Bakhsheshian et al. © 2016 American Academy of Neurology

Acute neurologic deficits due to Surfer’s Myelopathy MRI spine demonstrated findings consistent with Surfer's Myelopathy, a rare non-traumatic cause of myelopathy found in novice surfers.1, 2 Given the history, clinical and radiological findings, the postulated mechanism of injury is an ischemic event to the artery of Adamkiewicz. The is brought about by the prone hyperextended posture commonly associated with novice surfers. Patients that present with AIS B or better, compared to patients with complete SCI (ASI A) that typically do not recover.1 The patient in this vignette recovered full neurologic function over three days with conservative management. REFERENCES 1. Chang CW, Donovan DJ, Liem LK, et al. Surfers' myelopathy: a case series of 19 novice surfers with nontraumatic myelopathy. Neurology 2012;79:2171-2176. Nakamoto BK, Siu AM, Hashiba KA, et al. Surfer's myelopathy: a radiologic study of 23 cases. AJNR Am J Neuroradiol 2013;34:2393-2398. Bakhsheshian et al. © 2016 American Academy of Neurology