Sudden back pain as clinical presentation of spontaneous spinal epidural hematoma.

An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma (Figure). The patient underwent decompressive laminectomy of T12-L1. Spontaneous epidural hematoma is a rare disease, most often involving the thoracolumbar region, followed by the cervical region1. Non-traumatic causes include hypertension, coagulopathies, use of anticoagulants, arteriovenous abnormalities, tumors of the backbone and lumbar puncture. In approximately 40% of cases, the etiology cannot be determined. Typically, pain is the root of the acute onset, accompanied by neurological deficit1,2.