title: Spontaneous spinal epidural hemorrhage from intense piano playing.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Chiayi Christian Hospital, Chiayi City, 60002, Taiwan.
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Chiayi Christian Hospital, Chiayi City, 60002, Taiwan.
authors.forename: Fang Jy
authors.initials: FJ
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine, Chiayi Christian Hospital, Chiayi City, 60002, Taiwan; Department of Emergency Medicine, Medical Center & School of Medicine, Kaohsiung Medical University. Electronic address: Galaxy.bear@msa.hinet.net.
authors.forename: Ying C
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Chiayi Christian Hospital.
authors.forename: Shih-Han
authors.initials: SH
authors.lastname: Chen
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications; D001416:Back Pain / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009146:Music; D005082:Physical Exertion; D012422:Rupture, Spontaneous / Q000209:etiology; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000473:pathology