Spontaneous Spinal Epidural Hematoma Mimicking Stroke in a Young Patient: A Case Report

Abstract

Spontaneous spinal epidural hematoma (SSEH) is a rare but serious neurological emergency characterized by the accumulation of blood in the epidural space without an identifiable cause. It typically presents with sudden-onset neck or back pain, followed by motor and sensory deficits. Although uncommon, SSEH can mimic ischemic stroke when presenting as hemiparesis, often leading to diagnostic delays. We report the case of a 35-year-old male patient who developed sudden-onset cervical pain, followed by right-sided hemiparesis and sensory deficits. Due to focal neurological signs, an acute ischemic stroke was initially suspected; however, brain CT was unremarkable. Given the inconclusive findings, a cervicothoracic MRI was performed, which revealed an epidural mass extending from C3 to T2, consistent with SSEH. Surgical decompression confirmed a subacute epidural hematoma with no identifiable source of bleeding. The patient achieved complete neurological recovery within one month of surgery. This case highlights the importance of including SSEH in the differential diagnosis of acute hemiparesis, particularly when preceded by severe neck or back pain and without cranial nerve involvement. It also emphasizes the need to consider spinal imaging when initial brain CT is inconclusive in patients presenting with acute neurological deficits. Early recognition of these clinical features is crucial, as prompt surgical intervention significantly improves neurological outcomes and reduces the risk of long-term disability.

Keywords: case report; cervical pain; hemiparesis; spinal cord compression; stroke mimic.

Figure 1. Non-contrast brain and cervicothoracic CT scan showing an epidural hematoma causing spinal cord compression.

(A) Coronal plane: hyperdense epidural collection extending from C3 to T2 (solid red arrow). (B) Axial plane at C6: anterior displacement of the spinal cord (dashed red arrow).

Figure 2. Contrast-enhanced cervical MRI showing an epidural hematoma extending from C3 to T2, causing spinal cord compression.

(A) Coronal T2-weighted image: hyperintense epidural lesion (solid red arrow). (B) Axial T1-weighted image: isointense signal (dashed red arrow). (C) Axial T2-weighted image: hyperintense signal (solid white arrow). (D) Axial susceptibility-weighted image (SWI): peripheral hypointense rim with central hypointensity (dashed white arrow).

Figure 3. Intraoperative view of the cervical spine after C3-C7 laminectomy, showing a well-organized subacute epidural hematoma (white arrow).