Disclosures: Sargoon Nepaul, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 35-year-old female with spontaneous spinal cord hemorrhage

Case Description: A 35-year-old healthy female presented with weakness in the setting of cupping therapy two weeks prior. She presented with back pain radiating to the legs, loss of sensation below T4, 0/5 strength in lower extremities, and no rectal tone. MRI revealed an epidural hematoma compressing the spinal cord and thecal sac at the T2 level, eccentric to the right side. Per neurosurgery, she presented as T2 ASIA A and underwent emergent T2-T3 laminectomy. Post-surgery spinal MRA and angiogram found no identifiable source of the epidural hematoma.

Setting: Inpatient Rehabilitation FacilityAssessment/

Results: On admission to acute rehabilitation, the patient presented as T6 AIS D, non-traumatic paraplegia, as she had ⅘ strength in the lower extremity. She had a Foley after failing voiding trial but complete control of bowels and intact rectal tone and sensation on the exam. In rehab, the patient learned to self catheterize and was able to walk with contact guard assist. Four weeks after surgery, she presented to the outpatient clinic and was found to have regained most of her strength with persistent 4+/5 weakness in the right lower extremity. She had complete control over bowel movement but still required occasional self-catheterization with improving urinary retention.

Discussion: Cupping is an ancient alternative therapy in which special heated cups are placed to create suction. There have been several reported side effects of cupping: ranging from minor effects like keloid scarring to major effects like acquired hemophilia A, stroke, and factitious panniculitis. This is the first reported episode of an epidural hematoma as a result of cupping to our knowledge.

Conclusion: There are very few side effects of cupping noted in the literature, and adverse events associated with cupping should be identified in order to educate patients. Further research is required to understand the dynamics of cupping.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spontaneous-spinal-cord-hemorrhage-after-one-cupping-therapy-session-a-case-report/