Clinical Communications: Adults| Volume 48, ISSUE 4, P432-435, April 2015

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An Uncommon Cause of Acute Back Pain: Spinal Subarachnoid Hemorrhage Progressing to Spinal Cord Compression

  • Shane B. Kappler
    Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia
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  • Jonathan E. Davis
    Reprint Address: Jonathan E. Davis, md, Department of Emergency Medicine, Georgetown University School of Medicine, Ground Floor, CCC Building, 3800 Reservoir Road, NW, Washington, DC 20007
    Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia
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      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.


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