Primary spinal epidural hematoma mimicking stroke: A case report of rare diagnostic challenge

Spinal epidural hematoma is a rare and potentially life-threatening condition characterized by bleeding into epidural space, leading to spinal cord compression. With an incidence of approximately 1 per 1,000,000 annually, SEH requires urgent diagnosis and management to prevent irreversible neurological damage. This report highlights a case of primary spinal epidural hematoma causing acute spinal cord compression and hemiplegia mimicking stroke like features.

A 23-year-old male presented to the emergency department with acute upper back pain, progressive lower limb weakness, and bowel and bladder incontinence. Neurological examination revealed motor strength of 0/5 in the lower limbs, sensory loss in the perineal region, and preserved bulbocavernosus reflex. MRI of the spine demonstrated epidural hematoma compressing the spinal cord from C6 to D2. The patient underwent emergent laminotomy and hematoma evacuation. Postoperative recovery was uneventful, with significant improvement in neurological function.

Spinal epidural hematoma is a diagnostic challenge due to its nonspecific symptoms, which may mimic other conditions such as ischemic stroke. MRI remains the diagnostic gold standard. Timely surgical decompression is critical for favorable outcomes, especially in cases presenting significant neurological deficits.

This case emphasizes the importance of rapid recognition of SHE from stroke and spinal cord ischemia, imaging, and surgical management of Spinal epidural hematoma to mitigate severe neurological consequences. Awareness of this rare condition is vital for early diagnosis and effective treatment.