Which of the following is a relative contraindication for PRM?

• A. Coagulopathies
• B. Space occupying lesion in the cranium
• C. Increased intracranial pressure
• D. Post Concussive syndrome

Answer: (A)

The concept being tested is how to categorize contraindications for PRM in cranial osteopathic techniques. A relative contraindication means you should proceed with caution or modify the approach, weighing risks and benefits, rather than avoiding treatment entirely.

Coagulopathy fits as a relative contraindication because it raises the risk of bleeding if any tissue disruption occurs, even with the gentle, low‑force nature of PRM. The procedure is not typically prohibited, but bleeding risk means you must carefully consider whether benefits outweigh potential harm, and you may choose to alter the technique or avoid it in more severe coagulopathy.

In contrast, a space-occupying lesion in the cranium and increased intracranial pressure are considered absolute contraindications because manipulating the cranium could worsen pressure, reduce cerebral perfusion, or precipitate herniation, with serious consequences.

Post-concussive syndrome is not a contraindication; while symptoms may require caution and careful assessment, it does not by itself preclude performing PRM when clinically appropriate.