Acute Cervical Spinal Epidural Hematoma Following Cervical Massage: A Case Report

Case Report | DOI: https://doi.org/10.31579/2768-2757/216

Acute Cervical Spinal Epidural Hematoma Following Cervical Massage: A Case Report

  • José Clayton Balo *

Neurosurgery Department, Main Military Hospital Institute Superior, Luanda - Angola.

*Corresponding Author: José Clayton Balo., Neurosurgery Department, Main Military Hospital Institute Superior, Luanda - Angola.

Citation: José C. Balo (2026), Magnetic Resonance Imaging of the Brain in the Era of Artificial Intelligence: Advancing Precision While Preserving Clinical Judgment, Journal of Clinical Surgery and Research, 7(5); DOI:10.31579/2768-2757/216

Copyright: José C. Balo (2026), Magnetic Resonance Imaging of the Brain in the Era of Artificial Intelligence: Advancing Precision While Preserving Clinical Judgment, Journal of Clinical Surgery and Research, 7(5); DOI:10.31579/2768-2757/216

Received: 13 September 2026 | Accepted: 30 September 2026 | Published: 08 October 2026

Keywords: cervical spinal epidural hematoma; spinal cord compression; cervical spine; cervical massage; quadriparesis; spinal decompression

Abstract

Background: Cervical spinal epidural hematoma (CSEH) is a rare but potentially devastating cause of acute spinal cord compression. It typically presents with severe spinal pain followed by rapidly progressive neurological deficits. Cervical manipulation or massage has rarely been reported in temporal association with this condition.

Case Presentation: A 75-year-old man with a history of recurrent cervical pain was apparently well until five days before hospital admission, when he developed acute and progressively worsening cervical pain radiating to the left arm after a cervical massage performed at home. His condition progressed to severe weakness involving all four extremities, followed by urinary and fecal sphincter dysfunction. On admission, cervical pain was rated 8/10 on the visual analogue scale. Motor strength was 1/5 in the right upper limb, 2/5 in the left upper limb, and 0/5 in both lower limbs. Sensory function was preserved, and generalized osteotendinous hyperreflexia was present. Cervical computed tomography showed an epidural hematoma extending from C3 to C6 with left-sided spinal cord compression. Magnetic resonance imaging confirmed the diagnosis. The patient underwent C3–C6 laminoplasty, evacuation of the epidural blood clots, and fixation with microplates and microscrews.

Conclusion: CSEH should be considered in patients with acute severe cervical pain followed by rapidly progressive neurological deficits. A temporal relationship with cervical massage may be clinically relevant, although causality cannot be established from a single case. Prompt imaging and urgent decompression are central to management when severe neurological deficits and spinal cord compression are present.

1.Introduction

Spinal epidural hematoma (SEH) is an uncommon accumulation of blood in the epidural space that can cause acute compression of the spinal cord or nerve roots. The condition may be spontaneous, traumatic, iatrogenic, or associated with anticoagulation, antiplatelet therapy, vascular abnormalities, tumors, or coagulation disorders. The clinical pattern often consists of acute spinal pain, sometimes with radicular radiation, followed by motor, sensory, and autonomic dysfunction. Contemporary series and systematic reviews continue to emphasize the importance of rapid diagnosis and appropriate intervention. [1–6] Cervical SEH is particularly important because a relatively short longitudinal lesion can produce severe neurological impairment, including tetraparesis or tetraplegia. MRI is generally the preferred diagnostic examination because it defines the location, longitudinal extension, signal characteristics, and degree of spinal cord compression. CT may provide an important initial diagnostic clue, particularly in emergency settings. [1,3,7,8] The relationship between cervical manipulation or massage and epidural hematoma is uncommon but documented. A published case described a cervical epidural hematoma after cervical spine massage, while a more recent report described a cervicothoracic epidural hematoma after physiotherapy in an elderly patient receiving apixaban. These observations support clinical vigilance but do not establish that massage itself is a direct cause in every case. [9,10] The present report describes a 75-year-old man with severe neurological deterioration following acute cervical pain temporally associated with cervical massage, in whom a C3–C6 epidural hematoma with spinal cord compression was treated surgically.

2. Objective

To describe the clinical presentation, imaging findings, surgical management, and available follow-up of a 75-year-old man with an extensive C3–C6 cervical spinal epidural hematoma and severe neurological deficit following acute cervical pain temporally associated with cervical massage.

3. Methodology

3.1 Study design

 This manuscript was prepared as a single-patient clinical case report using a descriptive, retrospective observational approach. The reporting structure follows the CARE (CAse REport) framework, which recommends transparent reporting of patient information, clinical findings, diagnostic assessment, therapeutic interventions, follow-up, outcomes, and informed consent. [11,12]

3.2 Data source and case reconstruction

Clinical information was obtained from the patient's history, neurological examination, available radiological examinations, operative description, and outpatient follow-up information supplied by the treating team. The report was reconstructed chronologically from symptom onset through diagnosis, surgery, postoperative imaging, and rehabilitation follow-up.

3.3 Clinical assessment

Neurological motor function was documented using the 0–5 Medical Research Council muscle-strength convention as recorded in the clinical description. Because a formal American Spinal Injury Association Impairment Scale (AIS/ASIA) grade was not provided, the manuscript does not assign an AIS grade retrospectively. This distinction is important because AIS grades are categorical neurological impairment grades and should not be expressed as muscle-strength values.

3.4 Diagnostic assessment. Preoperative cervical CT and MRI were reviewed descriptively to establish the longitudinal extent of the epidural collection and its relationship with the spinal cord. The available images demonstrated a C3–C6 epidural hematoma with left-sided spinal cord compression.

3.5 Therapeutic intervention

The surgical intervention consisted of C3–C6 laminoplasty, evacuation of the epidural blood clots, and cervical fixation using microplates and microscrews. No additional etiological investigation, such as digital subtraction angiography or documented vascular malformation study, was available in the information supplied for this report.

3.6 Follow-up

 The patient is currently followed in the outpatient clinic and undergoes physiotherapy. Detailed serial postoperative motor scores, AIS grade, sphincter recovery, and standardized functional outcome measures were not available and therefore are not inferred.

3.7 Ethical and reporting considerations

The report should be submitted only after written informed consent for publication and anonymized clinical images has been obtained from the patient or his legally authorized representative. The manuscript is intended to comply with transparent case-reporting principles. The CARE checklist should be completed and submitted if requested by the journal. [11,12]

4. Case Presentation

4.1 Patient Information and Clinical History

A 75-year-old male patient with a history of recurrent cervical pain was apparently in good general health until five days before hospital admission. At that time, he developed acute cervical pain with progressive worsening and radiation to the left upper limb. The acute episode was temporally associated with cervical massage performed at home. The neurological condition progressively deteriorated, with reduction in strength in all four extremities. The patient subsequently developed urinary and fecal sphincter dysfunction. Because of the progressive neurological deterioration, his family brought him to the emergency department for further medical evaluation and treatment.

4.2 Neurological Examination

On assessment, the patient reported severe cervical pain, rated 8/10 on the visual analogue scale. There was severe motor impairment involving all four extremities. Upper-limb strength was documented as 1/5 on the right and 2/5 on the left, while both lower limbs had 0/5 strength. Sensory function was preserved. Generalized osteotendinous hyperreflexia was present. The combination of acute cervical pain, rapidly progressive tetraparesis, sphincter dysfunction, and preserved sensation suggested an acute cervical spinal cord compression syndrome.

4.3 Diagnostic Imaging

Preoperative cervical CT demonstrated an epidural hematoma extending from C3 to C6 with left-sided spinal cord compression (Figure 1). Cervical MRI confirmed the epidural hematoma and its compressive effect on the spinal cord (Figure 2). The imaging findings, in conjunction with the rapidly progressive neurological deficit, supported the diagnosis of an acute cervical spinal epidural hematoma requiring urgent decompressive management.

Figure 1: Preoperative cervical spine computed tomography. (A) Sagittal image demonstrating an epidural hematoma extending from C3 to C6. (B) Axial image demonstrating the epidural collection with left-sided spinal cord compression (red asterisk).

4.4 Surgical Treatment

Given the extensive cervical epidural hematoma, severe and progressive motor deficit, sphincter dysfunction, and spinal cord compression, urgent surgical decompression was performed. A C3–C6 laminoplasty was undertaken, followed by evacuation of the epidural blood clots. Cervical fixation was then performed using microplates and microscrews. The intraoperative photographs documented the evacuated epidural blood clots, the posterior cervical surgical field with fixation, and intraoperative radiographic confirmation of the instrumentation (Figure 3).

Figure 3: Intraoperative findings and surgical stabilization. (A) Evacuated epidural blood clots. (B) Posterior cervical surgical field with microplate fixation. (C) Intraoperative cervical radiograph demonstrating the fixation construct.

4.5 Postoperative Imaging and Follow-up

Postoperative cervical CT demonstrated the expected postoperative changes, including the decompressed posterior cervical region and the fixation construct. Sagittal, axial, and three-dimensional reconstructions documented the postoperative cervical anatomy and instrumentation (Figure 4).

Figure 4: Postoperative cervical spine computed tomography. (A) Sagittal reconstruction demonstrating postoperative changes from C3 to C6. (B) Axial image demonstrating the postoperative cervical changes and fixation. (C) Three-dimensional reconstruction showing the posterior cervical fixation construct.

The patient is currently followed in the outpatient clinic and undergoes physiotherapy. Detailed postoperative neurological scores and the degree of functional recovery at defined time points were not available in the information supplied for this report. These outcomes should be added before submission if they can be retrieved from the medical record.

5. Discussion

Cervical spinal epidural hematoma is a rare neurological emergency. Its clinical importance derives from the potential for rapid spinal cord compression and irreversible neurological injury. Recent literature continues to describe acute spinal pain followed by rapidly progressive motor deficits as a characteristic presentation. [1–5,7] In a 2024 retrospective surgical series of 26 patients with spontaneous spinal epidural hematoma, 31% of hematomas were cervical and 42% were cervicothoracic. Twenty-four patients (92%) improved after surgery, although a small subgroup remained with severe deficits. The authors concluded that surgical evacuation should be considered in symptomatic cases. (2) A 2022 multicenter retrospective study likewise evaluated prognostic factors and treatment efficacy in spontaneous spinal epidural hematoma, emphasizing the importance of neurological status and treatment selection. [4] A 2022 systematic review and meta-analysis by Vastani et al. included 181 studies and 295 surgically treated adult patients. The analysis identified preoperative neurological status, operative interval, operation type, and warfarin use among factors associated with postoperative outcome, supporting the importance of early recognition and appropriate surgical management. [3] Nakamura et al. specifically evaluated ultraearly evacuation, defining surgery within 12 hours of symptom onset, and found an association between ultraearly surgery and better functional outcome in symptomatic spontaneous spinal epidural hematoma. [5] A more recent 2025 review of spontaneous cervical epidural hematoma similarly examined surgical timing and neurological recovery, reinforcing the clinical importance of early decompression in patients with neurological deterioration. [1] The present patient had a severe neurological presentation, including marked weakness in all four extremities and sphincter dysfunction, together with radiologically confirmed C3–C6 spinal cord compression. These findings represent a clinical profile in which conservative observation would generally be difficult to justify, particularly in the presence of progressive neurological deterioration. The role of MRI is central. Kato and Terae described cervical spinal epidural hematoma as a potential stroke mimic and demonstrated how CT and MRI can establish the diagnosis in patients presenting with sudden neck pain and focal neurological deficits. [8] A 2026 case report further demonstrated that CT can provide an important initial diagnostic clue even in patients without overt neurological deficits, although MRI remained the confirmatory examination. [13] Etiology deserves particular attention. Spontaneous spinal hematomas may be associated with anticoagulant or antiplatelet therapy, vascular abnormalities, coagulation disorders, or remain idiopathic. In a 2024 case series of 20 spontaneous spinal hematomas, 55% of patients were receiving anticoagulants and vascular anomalies were identified in 25%; MRI was performed in all patients and digital subtraction angiography in a subset. [14] This finding supports consideration of a vascular or hematological evaluation when the clinical circumstances permit. The temporal relationship between cervical massage and the onset of symptoms is an important feature of this case. Ryu et al. reported a cervical epidural hematoma after cervical spine massage, emphasizing the need for rapid evaluation when neurological symptoms occur following manipulation. [9] More recently, El Mraiedh et al. reported an extensive cervicothoracic epidural hematoma following cervical physiotherapy in an elderly patient taking apixaban. [10] The present case shares the temporal relationship with cervical manipulation, but anticoagulant exposure was not documented in the information available. Therefore, the manuscript describes massage as a possible precipitating factor rather than a proven cause. Other reported mechanisms of spinal epidural hematoma include vascular fragility, venous rupture, anticoagulation, trauma, and structural spinal disease. Historical clinical series have emphasized that the exact source of bleeding is frequently not established. [15–18] Consequently, the absence of a documented traumatic event does not by itself establish a specific etiology. The extent of the hematoma in this patient, from C3 through C6, is clinically relevant because cervical hematomas can produce rapid deterioration in upper- and lower-extremity function. The decision to decompress and evacuate the hematoma was consistent with contemporary surgical practice for severe symptomatic cases. [1–5] The choice of C3–C6 laminoplasty with subsequent fixation differs from minimally invasive evacuation strategies described in some reports. Surgical exposure must be individualized according to hematoma location, extent, spinal stability, surgeon experience, and the need to obtain adequate decompression. Contemporary literature does not establish a single universal operative technique for all spinal epidural hematomas. [2,3,14] Recent reports also demonstrate that conservative management may be successful in carefully selected patients who have mild deficits or early, sustained neurological improvement. Wuyts and Dejaegher described two patients with severe initial deficits who improved early and were managed conservatively. [19] Similarly, the 2026 Oxford case report described complete recovery with conservative management in a patient without persistent neurological deficits. [13] These reports do not directly contradict surgical treatment in the present case because the patient described here had progressive severe motor and sphincter dysfunction with substantial cord compression. The patient's current outpatient physiotherapy is consistent with the need for rehabilitation after severe spinal cord compression. However, the absence of serial postoperative AIS examinations and standardized functional measures limits the ability to quantify neurological recovery. Future follow-up documentation should ideally include serial motor scores, sensory examination, sphincter status, ambulatory capacity, and a validated functional outcome measure. This case also illustrates a diagnostic safety principle: acute neck pain accompanied by rapidly evolving neurological deficits should prompt consideration of spinal pathology even when symptoms may initially resemble peripheral musculoskeletal disease or cerebrovascular disease. Early cervical imaging can be decisive. [8,13] Overall, the available literature supports three practical points relevant to this case: first, severe acute cervical pain followed by neurological deterioration should raise suspicion for cervical epidural hematoma; second, MRI is central to defining the lesion and cord compression; and third, severe or progressive neurological deficits with significant compression generally warrant urgent decompression and hematoma evacuation. [1–5,9,10,14,19]

6. Methodological Considerations and APA 7 Reporting

The methodological section was structured according to APA 7 principles for clear reporting of study design, data sources, clinical assessment, diagnostic procedures, intervention, follow-up, and limitations. Because this is a single-patient case report rather than an analytical clinical study, no inferential statistical analysis was performed. The primary unit of analysis was the individual patient, and the manuscript uses descriptive clinical reasoning rather than causal statistical inference. For transparency, the report distinguishes documented observations from interpretation. In particular, the temporal association between cervical massage and symptom onset is reported as an observation; a causal relationship is not claimed. This approach is consistent with case-report reporting principles, which emphasize completeness, transparency, and avoidance of unsupported causal conclusions. [11,12].

7. Limitations

Several limitations should be acknowledged. First, the available clinical information does not document a complete coagulation profile, platelet count, anticoagulant or antiplatelet medication history, or vascular investigation. These data would be relevant to etiological classification. Second, the exact interval between neurological deterioration and surgical decompression was not provided. Because treatment timing may influence outcome, this information should be retrieved from the medical record before submission. Third, postoperative neurological assessments were not provided in a standardized AIS/ISNCSCI format. Therefore, the degree of neurological recovery cannot be quantified in this report. Fourth, the MRI images were described clinically but were not supplied in the final image set available for this manuscript preparation. The original preoperative MRI should be inserted as Figure 2 before submission if available. Finally, a single case cannot establish causality between cervical massage and epidural hematoma. The association should therefore be presented as temporal rather than causal.

8. Conclusion

Cervical spinal epidural hematoma is a rare but potentially devastating cause of acute spinal cord compression. The combination of acute severe cervical pain and rapidly progressive tetraparesis or tetraplegia, particularly when accompanied by sphincter dysfunction, requires urgent spinal imaging. In this patient, CT and MRI demonstrated an extensive C3–C6 epidural hematoma with left-sided spinal cord compression. Because of the severe and progressive neurological deficit, surgical decompression with C3–C6 laminoplasty, evacuation of the epidural clots, and cervical fixation was performed. The temporal relationship with cervical massage is clinically noteworthy, but it does not establish causality. The case emphasizes the importance of considering cervical epidural hematoma after cervical manipulation when acute neurological deterioration occurs and of proceeding rapidly to diagnostic imaging and appropriate decompression.

9. Declarations

Conflict of Interest

The authors declare no conflict of interest.

Funding

No external funding was reported for this case report.

Patient Consent

Written informed consent for publication of the case and anonymized clinical and radiological images should be obtained from the patient or his legally authorized representative before submission.

Ethics Approval

The authors should confirm whether institutional ethics committee approval or a formal waiver/exemption is required for a single case report according to the applicable institutional policy.

Data Availability

The clinical information relevant to this case is contained within the manuscript. No directly identifying patient information should be submitted.

10. Author Contributions

The corresponding author coordinated the clinical case description, manuscript preparation, literature review, and revision. Contributions of additional authors should be specified and confirmed before submission.

References

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Hala Al Shaikh

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig