Idiopathic Spinal Epidural Hematoma: A Near Miss of a Rare Entity

Spinal epidural hematomas (SEH) are rare, and cases with a spontaneous etiology are even more infrequent. Management of spontaneous SEH varies, with surgical or conservative approaches determined by the severity of deficits and symptom resolution. Adverse prognostic factors may include thoracic segment location, anticoagulation use, severe neurologic deficits at admission, sphincter dysfunction, and rapid progression. We report a patient with a sudden onset of bilateral lower limb weakness and reduced urinary output. Magnetic resonance imaging was conducted and indicated an epidural hematoma extending from T11 to L4. Surgical decompression and hematoma extraction were performed successfully resulting in the complete resolution of symptoms. This case underscores the importance of considering spontaneous SEH in patients lacking conventional risk factors, such as a history of trauma, when presenting with symptoms of bilateral lower limb weakness and decreased urine output. Depending on the severity of symptoms and the occurrence of spontaneous and rapid improvement, the patient may benefit from surgical intervention, which ameliorated the patient's symptoms in this case.