Spontaneous Cervical Epidural Hematoma Following COVID-19 Illness Presenting to a Chiropractor: A Case Report

Abstract

Cervical epidural hematoma (CEH) is a rare and potentially fatal condition in which blood accumulates in the epidural space of the cervical spine.A 64-year-old man presented to a chiropractor with a two-week history of sudden-onset neck pain, shoulder pain, occipital headache, and numbness in the shoulders and upper extremities. He had recovered from a mild course of coronavirus disease 2019 (COVID-19) illness one month prior. The patient's primary care provider had previously prescribed a nonsteroidal anti-inflammatory drug for his neck pain. However, his symptoms worsened, and he visited the emergency department where he had unremarkable cervical spine radiographs and was discharged with a diagnosis of neck strain. The chiropractor ordered cervical spine magnetic resonance imaging (MRI), revealing a ventral CEH extending from C2 to C5. The chiropractor referred the patient to a nearby hospital for urgent management. The patient was admitted and observed, progressively improved, and did not require surgery. After 10 weeks in the hospital the patient was asymptomatic, a follow-up MRI revealed resolution of the CEH, and the patient was discharged.While the current case highlights a temporal relationship between COVID-19 and CEH, further research is needed to determine if COVID-19 is a risk factor for this condition. Clinicians who encounter patients with spinal disorders must be able to recognize the clinical features of CEH and refer these patients for emergency care and/or neurosurgical evaluation.

Meeting Future Demand for Chiropractic Services in Hong Kong: A Strategic Manpower Planning Approach

“…Patients with musculoskeletal and neuromusculoskeletal conditions must navigate unnecessary waits and referrals to access chiropractic care, increasing system burden [30]. In addition, as Hong Kong chiropractors often refer patients to nearby hospitals for urgent management [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], the current system delays immediate emergency care. The lack of chiropractic exposure in medical education also perpetuates solid system and inter-professional barriers.…”

A Rare Case of a Spontaneous Thoracic Epidural Hematoma in a Young Male Weightlifter

“…Spontaneous spinal epidural hematoma (SSEH) is a rare clinical manifestation occurring from the blood accumulating in the epidural space, resulting in spinal cord compression and neurological deficits most commonly without known trauma or other iatrogenic causes. SSEH affects mostly the thoracic region in the fourth or fifth decade of life with an estimated incidence of 0.1 patients per 100,000 annually [1,2]. Lesions can occur anywhere along the spinal tract; however, lesions in C6 to C7 and T12 are more common.…”

Colorectal Cancer Presenting as Sacral Pain at a Chiropractic Clinic

“…Chiropractic is a distinct healthcare profession focusing on the structural and functional changes of the spine and nervous system [2], and chiropractors are well educated to diagnose and treat neuromusculoskeletal disorders [3]. Although patients with life-threatening LBP rarely present to chiropractic clinics [4], many serious cases have been reported in Hong Kong involving patients seeking chiropractic care when they were unaware of the grave nature of their musculoskeletal symptoms [5][6][7][8][9][10][11][12][13][14]. Although the most frequent location for bone metastases from colorectal cancer is the spine [15], it is challenging to diagnose metastases based on clinical presentation alone, and chiropractors must maintain a high index of suspicion for "red flags" [16], such as pain disproportionate to clinical findings, pain at rest, and unintentional weight loss.…”