title: Cervical Epidural Hematoma after Chiropractic Spinal Manipulation Therapy in a Patient with an Undiagnosed Cervical Spinal Arteriovenous Malformation.
abstract: Spinal epidural hematoma (SEH) occurring after chiropractic spinal manipulation therapy (CSMT) is a rare clinical phenomenon. Our case is unique because the patient had an undiagnosed cervical spinal arteriovenous malformation (AVM) discovered on pathological analysis of the evacuated hematoma. Although the spinal manipulation likely contributed to the rupture of the AVM, there was no radiographic evidence of the use of excessive force, which was seen in another reported case. As such, patients with a known AVM who have not undergone surgical intervention should be cautioned against symptomatic treatment with CSMT, even if performed properly. Regardless of etiology, SEH is a surgical emergency and its favorable neurological recovery correlates inversely with time to surgical evacuation.
authors.affiliation: Department of Neurogurgery, Houston Methodist Neurological Institute.
authors.forename: Meng
authors.initials: M
authors.lastname: Huang
authors.affiliation: Department of Neurogurgery, Houston Methodist Neurological Institute.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Barber
authors.affiliation: Neurosurgery, Swedish Neuroscience Institute.
authors.forename: Marc
authors.initials: M
authors.lastname: Moisi
authors.affiliation: Department of Pathology and Laboratory Medicine, Houston Methodist Hospital.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Powell
authors.affiliation: Department of Pathology and Laboratory Medicine, Houston Methodist Hospital.
authors.forename: Andreana
authors.initials: A
authors.lastname: Rivera
authors.affiliation: Anesthesia and Critical Care, Houston Methodist Hospital.
authors.forename: Michael
authors.initials: M
authors.lastname: Zwillman
authors.affiliation: Department of Neurosurgery, University Medical Center Brackenridge.
authors.forename: James
authors.initials: J
authors.lastname: Rose
keywords: chiropractic manipulation; spinal arteriovenous malformation; spinal epidural hematoma