Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review

Tangtang Xiang; Xinjie Zhang; Yingsheng Wei; Dongyi Feng; Zhitao Gong; Xuanhui Liu; Jiangyuan Yuan; Weiwei Jiang; Meng Nie; Yibing Fan; Yupeng Chen; Jiancheng Feng; Shiying Dong; Chuang Gao; Jinhao Huang; Rongcai Jiang

doi:10.3389/fneur.2022.900145

Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review

Front Neurol. 2022 Jul 22:13:900145. doi: 10.3389/fneur.2022.900145. eCollection 2022.

Authors

Tangtang Xiang^{1

2}, Xinjie Zhang^{1

2}, Yingsheng Wei^{1

2}, Dongyi Feng^{1

2}, Zhitao Gong^{1

2}, Xuanhui Liu^{1

2}, Jiangyuan Yuan^{1

2}, Weiwei Jiang^{1

2}, Meng Nie^{1

2}, Yibing Fan^{1

2}, Yupeng Chen^{1

2}, Jiancheng Feng^{1

2}, Shiying Dong^{1

2}, Chuang Gao^{1

2}, Jinhao Huang^{1

2}, Rongcai Jiang^{1

2}

Affiliations

¹ Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
² Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China.

Abstract

Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.

Keywords: Atorvastatin; Intracranial Pressure Reduction; cupping therapy; dexamethasone; subdural hematoma (SDH).

Publication types

Case Reports