Spontaneous brachial plexus hemorrhage - Case report

BACKGROUND Shoulder hemorrhage resulting in brachial plexus neuropathy is a rare occurrence most often seen in cases of traumatic injury or anticoagul ation therapy. We report a unique case of spontaneous brachial plexus hemor rhage. CASE DESCRIPTION This is the first report of a spontaneous shoulder hemorrh age in which a 48-year-old jackhammer operator presented to the emergency d epartment with a sudden onset of right shoulder pain and upper extremity pa in and numbness. Imaging studies revealed a hematoma in the right axilla an d chest wall. Without evidence of active bleeding or worsening neurologic d eficit, this patient was treated conservatively with pain control and obser vation and eventually experienced a full recovery. Had there been persisten t neurologic deficit, however, surgical evacuation would have been indicate d. CONCLUSIONS Cases of, nerve compression caused by a hematoma should be anal yzed on the basis of the severity of the neurologic deficit and not on the underlying cause of bleeding. Conservative treatment may be indicated in ca ses of:mild or improving neurologic deficit, but regardless of its etiology , a hematoma that results in severe or worsening neurologic symptoms must b e surgically evacuated to prevent permanent nerve damage. (C) 2000 by Elsev ier Science Inc.