Surfer's Myelopathy with Magnetic Resonance Imaging Evidence Suggestive of Venous Congestion: A Case Report

Surfer's myelopathy is a rare, nontraumatic spinal cord injury affecting novice surfers. Although spinal ischemia is considered the primary mechanism, whether the initial insult is arterial or venous remains controversial. We report a case of surfer's myelopathy with magnetic resonance imaging findings suggestive of venous congestion-radiological features that, to our knowledge, have not been previously described. A previously healthy 23-year-old man developed acute low back pain, progressive lower limb weakness, and bladder and bowel dysfunction after his first surfing experience. Magnetic resonance imaging on admission showed longitudinal T2 hyperintensity from T8/9 to the conus medullaris without abnormalities on diffusion-weighted imaging. On day 2, repeat magnetic resonance imaging again demonstrated no diffusion-weighted imaging changes, whereas the apparent diffusion coefficient map revealed hyperintensity, indicating vasogenic edema. These findings were more consistent with venous rather than arterial ischemia. The patient was treated with antiplatelet and anticoagulation therapy along with rehabilitation and ultimately achieved complete neurological recovery. This case may represent the first description of magnetic resonance imaging findings suggestive of venous congestion in surfer's myelopathy. Apparent diffusion coefficient hyperintensity in the absence of diffusion restriction may reflect reversible venous ischemia. Incorporating diffusion-weighted imaging and apparent diffusion coefficient maps into routine magnetic resonance imaging protocols for suspected surfer's myelopathy could provide valuable insight into pathophysiology and prognosis.