A previously healthy 22-year old man travelled from Canada to Central America.  After vacationing for 72 hours, he developed bilateral lower extremity weakness and sensory alteration with urinary retention over several hours.  The day before symptom onset, he had been riding an all-terrain vehicle (ATV), resulting in lower back discomfort.  Neurologic examination was consistent with anterior cord syndrome.  MRI spine demonstrated anterior cord T2 hyperintensity extending from T11 to the conus medullaris.  Infectious and hypercoagulability work-up were negative. Time-resolved MR angiography of the spinal cord did not demonstrate a vascular malformation.  He received high dose intravenous steroids without clinical benefit.  Overall, his presentation was most consistent with anterior spinal cord infarction.  Two weeks after symptom onset, he was found to have a small pulmonary embolus, believed to be secondary to immobilization and was started on rivaroxaban.  After 3 months, rivaroxaban was discontinued and he was advised to continue with lifelong acetylsalicylic acid. 

Recent case reports have identified clinical presentations similar to surfer’s myelopathy with other activities involving spine hyperextension, including cheerleading and gymnastics. This case illustrates a clinical presentation of anterior thoracolumbar cord infarction consistent with surfer’s myelopathy after spine hyperextension during ATV riding, in the context of dehydration and long-distance air travel.