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.
Subject(s)
Athletic Injuries/diagnostic imaging , Diffusion Tensor Imaging/methods , Spinal Cord Injuries/diagnostic imaging , Water Sports , Adolescent , Athletic Injuries/complications , Athletic Injuries/drug therapy , Edaravone/administration & dosage , Female , Glycerol/administration & dosage , Humans , Infusions, Intravenous , Methylprednisolone/administration & dosage , Paraplegia/drug therapy , Paraplegia/etiology , Rectal Diseases/drug therapy , Rectal Diseases/etiology , Spinal Cord Diseases , Spinal Cord Injuries/complications , Spinal Cord Injuries/drug therapy , Time Factors , Treatment Outcome , Urinary Bladder Diseases/drug therapy , Urinary Bladder Diseases/etiologyABSTRACT
A 66-year-old woman presented with vertigo and deafness. Diffusion-weighted magnetic resonance imaging of the head showed multiple cerebral infarctions involving several blood vessel regions. A diagnosis of cardiogenic embolism was made, and anticoagulation therapy was begun. The woman had no additional symptoms until suddenly developing left hemiparesis one year later. She was again found to have multiple cerebral infarctions. The hemiparesis gradually improved, but ataxic gait and apraxia appeared and progressed over two weeks. Holter ECG, carotid ultrasound, and transthoracic/transesophageal echocardiography revealed no evidence of cardiogenic embolism. However, serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL2R) levels were elevated (LDH, 782â IU/l; sIL2R, 1,396â IU/ml), which suggested malignant lymphoma. Contrast chest/abdominal CT scan and gallium-67 scintigraphy revealed no evident lesions; however, random skin biopsy and open brain biopsy showed that blood vessels were infiltrated by CD20-positive atypical lymphocytes. These findings were consistent with intravascular large B-cell lymphoma. This type of lymphoma is known as a rapidly progressive disease with poor prognosis, but this case followed an indolent course, with a one-year interruption in disease progression.
