• Alissara Vanichkulbodee, Suwara Issaragrisil, and Pholaphat Charles Inboriboon.
• 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.
• Am J Emerg Med. 2019 Apr 1; 37 (4): 797.e1-797.e4.

BackgroundSpinal epidural hematoma (SEH) is an uncommon but serious emergency condition rare cases of spontaneously or following a minor traumatic event without bony injury.ObjectiveWe report the rare case of SEH associated with traditional massage initially presenting with delayed lower paraplegia.Case ReportA 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.ConclusionEmergency 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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