Spontaneous spinal epidural hematoma – an
uncommon cause of acute neurologic deficit
in the emergency department: a case report
Dublin Core
Title
Spontaneous spinal epidural hematoma – an
uncommon cause of acute neurologic deficit
in the emergency department: a case report
uncommon cause of acute neurologic deficit
in the emergency department: a case report
Subject
Spontaneous spinal epidural hematoma, Antiplatelet therapy, Emergency department
Description
Abstract
Background We present here an uncommon case of spontaneous spinal epidural hematoma (SSEH) likely secondary
to antiplatelet use. Its early recognition in the Emergency Department (ED) proves to be a challenge as presentation
mimics more common causes of acute neurological deficit leading to diagnostic delays and suboptimal treatment
outcomes.
Case Presentation A 63-year-old Chinese man with significant comorbidities including end stage renal failure on
haemodialysis, hypertension, diabetes mellitus and recent myocardial infarction treated with percutaneous coronary
intervention and dual antiplatelet therapy (DAPT) presented to the ED, complaining of acute onset non-traumatic
neck and upper thoracic pain with quadriparesis. Magnetic Resonance Imaging (MRI) of the cervical and thoracic
spine revealed an acute-subacute posterior epidural hematoma extending from the level of C5 to the level of T7
compressing the cord up to the level of T5. Despite decompression surgery, the patient remained paraplegic at
30-day follow-up.
Conclusion SSEH is a time critical neurosurgical emergency that should be suspected in patients with acute
onset axial neck or back pain and rapidly progressive myelopathic signs. Emergency physicians should use bedside
discriminators like axial pain, sensory level, sphincter involvement and cranial nerve sparing to trigger urgent spine
MRI and early surgical consultation when SSEH is suspected. This recognition is central to optimizing prognosis and
guiding realistic counselling.
Keywords Spontaneous spinal epidural hematoma, Antiplatelet therapy, Emergency department
Background We present here an uncommon case of spontaneous spinal epidural hematoma (SSEH) likely secondary
to antiplatelet use. Its early recognition in the Emergency Department (ED) proves to be a challenge as presentation
mimics more common causes of acute neurological deficit leading to diagnostic delays and suboptimal treatment
outcomes.
Case Presentation A 63-year-old Chinese man with significant comorbidities including end stage renal failure on
haemodialysis, hypertension, diabetes mellitus and recent myocardial infarction treated with percutaneous coronary
intervention and dual antiplatelet therapy (DAPT) presented to the ED, complaining of acute onset non-traumatic
neck and upper thoracic pain with quadriparesis. Magnetic Resonance Imaging (MRI) of the cervical and thoracic
spine revealed an acute-subacute posterior epidural hematoma extending from the level of C5 to the level of T7
compressing the cord up to the level of T5. Despite decompression surgery, the patient remained paraplegic at
30-day follow-up.
Conclusion SSEH is a time critical neurosurgical emergency that should be suspected in patients with acute
onset axial neck or back pain and rapidly progressive myelopathic signs. Emergency physicians should use bedside
discriminators like axial pain, sensory level, sphincter involvement and cranial nerve sparing to trigger urgent spine
MRI and early surgical consultation when SSEH is suspected. This recognition is central to optimizing prognosis and
guiding realistic counselling.
Keywords Spontaneous spinal epidural hematoma, Antiplatelet therapy, Emergency department
Creator
Arjun Thompson1*, Alston Guan Jie Ong2
and Yuan Helen Zhang1
and Yuan Helen Zhang1
Source
https://doi.org/10.1186/s12245-025-01031-x
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Arjun Thompson1*, Alston Guan Jie Ong2
and Yuan Helen Zhang1, “Spontaneous spinal epidural hematoma – an
uncommon cause of acute neurologic deficit
in the emergency department: a case report,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12869.
uncommon cause of acute neurologic deficit
in the emergency department: a case report,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12869.