Repeated Recurrence of Spontaneous Cervical Epidural Hematoma Associated with Habitual Strength Training

Spontaneous spinal epidural hematoma is a clinical entity as a hematoma occurring in the spinal epidural space with unknown etiology. It is known to sometimes show spontaneous regression, and recurrence is rare and repeating even rarer. We had an experience of repeated recurrent spontaneous spinal epidural hematoma, eventually leading to surgery. A 25-year-old man, a habitual exerciser of strength training, had a sudden onset of cervical back pain during sleep the same night after training. Radiological examinations revealed a cervical epidural hematoma but no vascular anomalies, and the patient's symptoms and the hematoma resolved rapidly and spontaneously in a day. Within 2.5 years, he had another three more similar hemorrhagic episodes with rapid and spontaneous resolution. On the 5th episode, the patient underwent surgical treatment with removal of the epidural tissue and packing of the epidural space. The pathological diagnosis was only the normal connective tissue and veins. He has had no recurrence in the 1.5 years after surgery with the same strength training as before. The appropriate timing and method of treatment for recurrent spontaneous spinal epidural hematoma with rapid resolution is still under debate, but surgery should be considered if there are multiple recurrences. It is important to collapse the epidural space with packing to prevent further recurrence.