Spontaneous spinal epidural hematoma - an uncommon cause of acute neurologic deficit in the emergency department: a case report.

backgroundWe 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.

conclusionSSEH 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.