Flail arm syndrome: a distinctive variant of amyotrophic lateral sclerosis

region.Such an extensive haematoma is very uncommon. 1 4Literature review suggests that SSEDH involving more than two vertebral levels carries a worse prognosis. 1 2Hence, the rapid recovery seen in our patient despite such an extensive haematoma is remarkable.Improving clinical condition, extensive haematoma, age, and poor medical condition of the patient prompted us to pursue conservative treatment with good clinical and radiological improvement.Although emergency surgery is the treatment of choice, non-surgical therapy in the medically unfit, patients with minor deficits, and in patients with initial clinical improvement, has yielded good results, in all the aetiological groups, 1 3 4 which fits with our experience.Fresh frozen plasma, Vitamin K, and monitoring of INR have been the mainstay of conservative treatment in patients on anticoagulants, who need repeat MRI for follow up. 3 4 With the ever increasing number of patients on anticoagulant therapy for cardiovascular diseases, SSEDH is likely to become a more common problem.When to restart anticoagulant therapy and the optimal INR values to be maintained after restarting are the questions still unanswered in the literature.In summary, SSEDH in patients taking anticoagulant drugs with initial clinical improvement may be successfully treated with regular clinical, haematological, and MRI monitoring even if they have extensive clots.