Spontaneous Resolution of a Traumatic Lumbar Epidural Hematoma with Transient Paraparesis

To clinically and radiologically report a traumatic spinal epidural hematoma (SEH) that completely resolved, without surgical treatment. A 17-year-old woman presented with back pain, lower motor weakness, and sensory change after trauma to the lower back area. Neurologic examination revealed paraparesis (grade 3/5) and radiating pain in both legs at the L5 dermatome. Magnetic resonance imaging (MRI) of the lumbar spine showed a spaceSEH-occupying lesion in the ventral spinal epidural space at the L4 level. The lesion was consistent with acute stage hematoma in the spinal epidural space. The patient was prepared for decompression surgery. However, the patient’s neurologic symptoms began to improve (grade 4+/5) at 2 hr after the onset of paraparesis. Surgical intervention was delayed, and the patient was treated conservatively with close neurologic monitoring. Two days after the onset of symptoms, the patient’s neurologic symptoms recovered completely. The follow-up MRI at 3 days after the event showed complete resolution of the epidural hematoma. A SEH can occur after blunt trauma to the spine. This case illustrates that immediate surgical intervention may not always be necessary in some patients with traumatic SEH. Conservative management may be a possible option for patients presenting with neurologic dysfunction if neurological symptoms recover rapidly.