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Spinal epidural hematoma after stretch exercise: a case report

      Spinal epidural hematoma (SEH) is a rare but serious condition. Common causes of SEH include spinal fracture, spinal trauma, and invasive spinal procedures such as lumbar puncture, epidural anesthesia, or myelography. A few previous reports have suggested that SEH could be caused by minor triggers such as spinal manipulation therapy or spontaneously in rare cases. A 60-year-old man, immediately after stretch exercise, developed severe back cervicodynia and rapidly progressive weakness of left arm from SEH. He was treated by decompression laminectomy and evacuation of the hematoma. However, the upper extremity weakness did not completely resolve. The standard treatment remains timely surgical decompression and evacuation of the hematoma. Thus, early diagnosis and treatment can confer a significant prognostic advantage to patients with SEH. Based on the finding that SEH was caused by a mild mechanical trigger and neurologic deficits remained in this patient, this report highlights its diagnostic difficulty as well as the importance of rapid treatment. Emergency physicians should consider SEH among the differential diagnosis in patients with sudden-onset back pain with symptoms and signs of spinal cord compression.
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      References

        • Lonjon M.M.
        • Paquis P.
        • Chanalet S.
        • et al.
        Nontraumatic spinal epidural hematoma: report of four cases and review of the literature.
        Neurosurgery. 1997; 41 ([discussion 486-7]): 483-486
        • Tseng S.H.
        • Chen Y.
        • Lin S.M.
        • et al.
        Cervical epidural hematoma after spinal manipulation therapy: case report.
        J Trauma. 2002; 52: 585-586
        • Van Schaeybroeck P.
        • Van Calenbergh F.
        • Van De Werf F.
        • et al.
        Spontaneous spinal epidural hematoma associated with thrombolysis and anticoagulation therapy: report of three cases.
        Clin Neurol Neurosurg. 1998; 100: 283-287
        • Samkoff L.M.
        • Daras M.
        • Kleiman A.R.
        • et al.
        Spontaneous spinal epidural hematoma. Another neurologic complication of cocaine?.
        Arch Neurol. 1996; 53: 819-821
        • Beatty R.M.
        • Winston K.R.
        Spontaneous cervical epidural hematoma. A consideration of etiology.
        J Neurosurg. 1984; 61: 143-148
        • David S.
        • Salluzzo R.F.
        • Bartfield J.M.
        • et al.
        Spontaneous cervicothoracic epidural hematoma following prolonged Valsalva secondary to trumpet playing.
        Am J Emerg Med. 1997; 15: 73-75
        • Uber-Zak L.D.
        • Venkatesh Y.S.
        Neurologic complications of sit-ups associated with the Valsalva maneuver: 2 case reports.
        Arch Phys Med Rehabil. 2002; 83: 278-282
        • Miyagi Y.
        • Miyazono M.
        • Kamikaseda K.
        Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma. Case report.
        J Neurosurg. 1998; 88: 909-911
        • Segal D.H.
        • Lidov M.W.
        • Camins M.B.
        Cervical epidural hematoma after chiropractic manipulation in a healthy young woman: case report.
        Neurosurgery. 1996; 39: 1043-1045
        • Morio Y.
        • Kuranobu K.
        • Yamamoto K.
        Chronic spontaneous cervical epidural hematoma. Report of a case presenting with only radicular symptoms.
        Spine. 1993; 18: 405-407
        • Groen R.J.
        • van Alphen H.A.
        Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome.
        Neurosurgery. 1996; 39 ([discussion 508-499]): 494-508
        • Hentschel S.J.
        • Woolfenden A.R.
        • Fairholm D.J.
        Resolution of spontaneous spinal epidural hematoma without surgery: report of two cases.
        Spine. 2001; 26: E525-E527