A Spontaneous Thoracic Spinal Epidural Hematoma Causing Hemiplegia and Back Pain

Spontaneous spinal epidural hematoma (SEH) is described as a spontaneous collection of blood in the spinal epidural space and often causes devastating sequelae unless it is diagnosed in time and effectively managed. Incidence rate is estimated at 0.1 per 100,000 individuals. Studies show that most cases occur in >40 year-olds (1, 2). Ethiopathogenesis is usually related to neoplasms, coagulopathy, vascular malformation, traumas, drugs; however, in up to 40% cases, no underlying cause is identified. SEH mostly presents as acute to subacute pain at the level of the spinal hemorrhage, and neurological symptoms may develop including sensory disturbance, progressive weakness, urine and stool retention or incontinence, and paralysis. Atypical SEH may appear as an acute ischemic stroke or myocardial infarction (3). We report a case of thoracic spinal epidural hematoma associated with acute hemiplegia, which was treated with decompression with 100% recovery.