Disclosures: Elliot Chan, MD: No financial relationships or conflicts of interest

Case Description: A healthy, athletic 18-year-old male presented with gradual onset bilateral lower extremity weakness after a first-time surfing lesson, without any trauma or injury. MRI of the thoracolumbar spine showed a long segment of hyperintense T2 signal in the central spinal cord extending from T5-T12 that was consistent with infarction. ASIA Impairment Scale (AIS) exam showed a Grade C injury at the level of T7 with neurogenic bladder and bowel.

Setting: Tertiary care pediatric hospital.

Patient: 18-year-old male student. Assessment/

Results: The patient was treated for 10 days with high-dose dexamethasone (10mg intravenously every 6 hours) and an induced hypertension protocol using intravenous phenylephrine and fluids to maintain a mean arterial pressure above 90mmHg. After undergoing six weeks of inpatient rehabilitation, the patient’s AIS score improved to Grade D at the level of L2, with recovery of volitional bowel and bladder function.

Discussion: Surfer’s myelopathy was first described in a 2004 published case series of nine patients that developed thoracic spinal cord injury after taking surfing lessons in Hawaii. Imaging classically shows a “pencil-like” longitudinal segment of signal change in the central spinal cord. The mechanism of injury is unclear but is hypothesized to be related to prolonged hyperextension or repeated flexion/extension of the spine, which causes vascular injury and spinal cord infarction. Treatment protocols in published cases varied greatly, and prognosis was dependent on the severity of injury and possibly the initial treatment utilized.

Conclusion: Surfer’s myelopathy is a rare diagnosis that classically occurs in novice surfers. In regions such as Hawaii and Southern California, physicians must be aware of this clinical presentation as timely recognition and treatment has been demonstrated to be important for overall prognosis. Though there is no gold-standard treatment protocol, we propose that high-dose steroids and induced hypertension can play a role in successful recovery.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/surfers-myelopathy-treated-with-steroids-and-induced-hypertension-a-case-report/