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.