Spontaneous Spinal Epidural Hematoma Presenting as Acute Paraplegia

Abstract

Background: Spontaneous spinal epidural hematoma is a rare condition which can have disabling neurological complications. Prompt timely surgical management may promote recovery even in severe cases. Timely recognition and diagnosis is essential for proper treatment. Objective: To describe a case of spontaneous spinal epidural hematoma with acute presentation which was treated surgically with good outcomes. Presentation of Case: We report a 66-year-old man with a four hour history of sudden severe upper back pain, followed by complete weakness and numbness over the bilateral lower limbs. A spinal magnetic resonance imaging scan was performed and revealed a posterior epidural hematoma of the cervicothoracic spine. He underwent an emergency decompressive laminectomy of the spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 4 weeks, significant improvement in weakness and ambulation with assistance was resumed. The diagnosis of spontaneous spinal epidural hematoma must be considered in patients presenting with acute onset of back pain along with symptoms of compression of the spinal cord. Early recognition of the problem, proper investigations and diagnosis and prompt surgical treatment may result in significant improvement even in severe cases.