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Am J Emerg Med. 2019 Jan 15. pii: S0735-6757(19)30024-5. doi: 10.1016/j.ajem.2019.01.017. [Epub ahead of print]

Massage-induced spinal epidural hematoma presenting with delayed paraplegia.

Author information

1
Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Samsen, Dusit, Bangkok, 10300, Thailand; Truman Medical Center, Department of Emergency Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, Mo, USA. Electronic address: alissara115@gmail.com.
2
Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Samsen, Dusit, Bangkok, 10300, Thailand. Electronic address: suwara@nmu.ac.th.
3
Truman Medical Center, Department of Emergency Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, Mo, USA. Electronic address: Charlie.Inboriboon@tmcmed.org.

Abstract

BACKGROUND:

Spinal epidural hematoma (SEH) is an uncommon but serious emergency condition rare cases of spontaneously or following a minor traumatic event without bony injury.

OBJECTIVE:

We report the rare case of SEH associated with traditional massage initially presenting with delayed lower paraplegia.

CASE REPORT:

A 20-year-old man presented with bilateral lower extremity weakness and numbness 3 h prior to presentation. 3 days prior he was given a layperson Thai massage by a friend. Magnetic resonance imaging revealed a spinal epidural lesion suspicious for hematoma extending from C6 to T2 levels. Emergent surgical intervention for cord decompression was performed. An epidural hematoma with cord compression at C6-T2 levels was identified intraoperatively. No evidence of abnormal vascular flow or AV malformations was identified. Similar to chiropractic manipulation, massage may be associated with spinal trauma.

CONCLUSION:

Emergency physicians must maintain a high index of suspicion for spinal epidural hematomas in patients with a history of massage or chiropractic manipulation with neurologic complaints, because delays in diagnosis may worsen clinical outcome.

KEYWORDS:

Delayed paraplegia; Post chiropractic manipulation; Post massage; Spinal epidural hematoma

PMID:
30691861
DOI:
10.1016/j.ajem.2019.01.017

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