Left shoulder pain in patients with old myocardial infarction could be a neuropathic pain from spinal epidural haematoma

Description 

A 66-year-old Japanese man with medical history of old myocardial infarction and on daily aspirin presented to the emergency department with sudden onset of severe left shoulder pain. He reported no prior trauma and denied cold sweat, vomiting, chest or back pains. At the time of initial evaluation, cardiac and neurological examinations were normal and there was no tenderness over the shoulder joints or the spine. A diagnosis of acute myocardial infraction or aorta dissection was first suspected. However, ECG, serum troponin T concentration and contrast-enhanced CT of the chest showed negative results.

The patient was admitted to the emergency department under the diagnosis of possible acute coronary syndrome. But, several hours later, he suddenly developed mild weakness of the left upper and lower extremities without facial muscle involvement. Urgent MRI revealed cervical spinal epidural haematoma (SEH) with spinal cord compression mainly to the left side (

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