Spontaneous cervical epidural hematoma masquerading as an abscess on magnetic resonance imaging scan

The aims of the study are to describe a case of spontaneous spinal epidural hematoma (SSEH) without any predisposing factors and magnetic resonance imaging (MRI) features of epidural abscess and to highlight the importance of high clinical suspicion.

A 75-year-old male presented to the emergency department after a severe neck pain. He progressively showed sensory and upper motor signs on the left side of the body. The MRI scans were suggestive of cervical epidural abscess with peripheral enhancement of the lesion.

He underwent a multiple level (C3-T1) laminectomy when he was found to have an SSEH. There has been no history of trauma or other predisposing factor, and presence of arteriovenous malformation was ruled out by MR angiography.

The MRI features of SSEH may be misleading and mimic other spinal lesions such as abscess. Presence of tapering superior and inferior margins, spotty Gadolinium enhancement in the mass, along with abrupt clinical onset of pain and neurologic deficit, should raise the suspicion toward epidural hematoma. Enhancement in the hyperacute stage of the hematoma itself might indicate continued bleeding and, in the case of deteriorating neurologic status, will necessitate decompression.