Spontaneous spinal epidural hematoma inducing acute anterior spinal cord syndrome

Spontaneous spinal epidural hematoma (SSEH) is rare. Its etiology remains controversial; however, spinal venous wall susceptibility to intravenous pressure change and the resultant venous rupture seem to be involved. The authors report a case of SSEH dorsal to the spine producing acute anterior spinal cord syndrome. A posterior SSEH between the C-3 and T-5 levels caused progressive tetraparesis and the disappearance of superficial body sensation below the level of C-8, although deep sensation remained completely intact. This neurological false localizing sign seems to have resulted from counterforce by preexisting asymptomatic cervical intervertebral disc herniation at the C6-7 levels inducing direct pressure on the anterior spinal cord. This case is the first reported instance of posterior cervical SSEH manifesting acute anterior spinal cord syndrome as its false localizing sign.