| emergency department

Cervical Epidural Hematoma

Life Threatening Extrinsic Causes

An article in the Cureus journal reports on a young, healthy man whose shoulder pain led to limb weakness and then bowel and bladder incontinence. Systemic examination unearthed nothing suspicious. An MRI showed spontaneous cervical epidural hematoma causing cord compression. The article states, “A spinal epidural hematoma is typically considered a surgical emergency. This is a rare condition with a reported incidence of zero to one per 1,00,000 per year, although, with the wider usage of MRI, the incidence has increased in recent years. It can occur secondary to trauma, tumor, coagulopathy, vascular malformation, cavernous angioma, or can be spontaneous.”

“The patient underwent an emergency C7-T1 laminectomy with hematoma evacuation. Around 24 h postoperatively, the power improved to 4/5 in all four limbs. The patient was discharged on day 10 with full power in all four limbs and continent bladder and bowel.” The study concluded, “Shoulder pain results from multiple conditions and reaching an accurate diagnosis may require a battery of investigations. Often, all of these investigations can’t be performed in the emergency setting, but life-threatening extrinsic and intrinsic causes must be ruled out in every patient as far as possible. Patient education is also extremely important here as some patients may delay seeking medical attention or be lost to follow-up, delaying diagnosis and timely interventions.”

 

Read the journal article.

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