An uncommon cause of acute back pain: spinal subarachnoid hemorrhage progressing to spinal cord compression

Shane B Kappler; Jonathan E Davis

doi:10.1016/j.jemermed.2014.11.009

An uncommon cause of acute back pain: spinal subarachnoid hemorrhage progressing to spinal cord compression

J Emerg Med. 2015 Apr;48(4):432-5. doi: 10.1016/j.jemermed.2014.11.009. Epub 2015 Jan 22.

Authors

Shane B Kappler¹, Jonathan E Davis¹

Affiliation

¹ Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia.

PMID: 25618833
DOI: 10.1016/j.jemermed.2014.11.009

Abstract

Background: Spinal subarachnoid hemorrhage (SSH) is an uncommon occurrence responsible for <1% of all cases of subarachnoid hemorrhage (SAH).

Case report: We present the case of a 53-year-old man who presented to the emergency department (ED) with acute onset of "tearing" back pain that began during activity, and who was diagnosed with an SSH that ultimately progressed to spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, the consequences of SSH are potentially devastating, yet reversible, making awareness of this condition critical. Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. Pain that is described as "tearing" or that is unresponsive to ordinary analgesic dosages should prompt strong consideration of vascular or other serious pathology, including arterial dissection or spinal cord compression.

Keywords: back pain; compression; emergency; spinal cord; subarachnoid hemorrhage.

Publication types

Case Reports

MeSH terms

Acute Disease
Back Pain / etiology*
Diagnosis, Differential
Humans
Male
Middle Aged
Spinal Cord Compression / etiology*
Subarachnoid Hemorrhage / complications*