A 56-year-old non-diabetic woman with no evidence of prior SARS-CoV-2 infection presented with profound left upper arm pain, soreness and curtailed movement. Because of disabling pain she could hardly carry her handbag. The patient reported no unaccustomed or vigorous exercise or heavy manual labor prior to the onset of symptoms. Pain had developed 8 days after a second dose of COVID-19 vaccine into her deltoid muscle and produced decreased range of motion and progressive weakness. She had no systemic symptoms as malaise and fever. Upon physical examination, there were no signs of skin erythema or swelling. There was tenderness over the deltoid muscle, guarding and decreased abduction of the shoulder and arm. Serologic testing yielded increased serum creatine kinase concentration suggesting skeletal muscle damage. Urine analysis excluded myoglobinuria. At MRI for investigation of muscle pain and dysfunction, middle head of the deltoid muscle appeared severely edematous, with no apparent tearing or abscess ( Figure 1a). Deltoid muscle architecture was preserved and edema appeared to track along the muscle fascicles. On contrast-enhanced MR images, affected muscle exhibited prominent enhancement indicating inflammation (myositis) ( Figure 1b). Management consisted of rest, cryotherapy, compression and NSAIDs to decrease subjective pain. Symptoms resolved over the course of 6 weeks with no residual loss of function. Interestingly, MR findings persisted almost 2 months past resolution of symptoms.

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed.