Spontaneous spinal epidural hemorrhage from intense piano playing

Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagul...

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Bibliographic Details
Published in:The American journal of emergency medicine 2014-06, Vol.32 (6), p.688.e3-688.e5
Main Authors: Chang, Hui-Ju, Su, Fang Jy, MD, Huang, Ying C., MD, Chen, Shih-Han, MD
Format: Article
Language:English
Subjects:
Adult
Arteriovenous Malformations - complications
Back Pain - etiology
Biomechanics
Blood platelets
Blood pressure
Compression therapy
Emergency
Emergency medical care
Emergency Service, Hospital
Female
Heart
Heart rate
Hematoma, Epidural, Spinal - diagnosis
Hematoma, Epidural, Spinal - etiology
Humans
Hypertension
Magnetic Resonance Imaging
Music
NMR
Nuclear magnetic resonance
Physical Exertion
Pregnancy
Rupture, Spontaneous - etiology
Spinal cord
Spinal Cord Compression - diagnosis
Spinal Cord Compression - etiology
Thoracic Vertebrae - blood supply
Thoracic Vertebrae - pathology
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Summary:Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2013.12.017