Spontaneous Spinal Epidural Hematoma Mimicking Stroke in a Young Patient: A Case Report

Spontaneous spinal epidural hematoma (SSEH) is a rare but serious neurological emergency characterized by the accumulation of blood in the epidural space without an identifiable cause. It typically presents with sudden-onset neck or back pain, followed by motor and sensory deficits. Although uncommon, SSEH can mimic ischemic stroke when presenting as hemiparesis, often leading to diagnostic delays. We report the case of a 35-year-old male patient who developed sudden-onset cervical pain, followed by right-sided hemiparesis and sensory deficits. Due to focal neurological signs, an acute ischemic stroke was initially suspected; however, brain CT was unremarkable. Given the inconclusive findings, a cervicothoracic MRI was performed, which revealed an epidural mass extending from C3 to T2, consistent with SSEH. Surgical decompression confirmed a subacute epidural hematoma with no identifiable source of bleeding. The patient achieved complete neurological recovery within one month of surgery. This case highlights the importance of including SSEH in the differential diagnosis of acute hemiparesis, particularly when preceded by severe neck or back pain and without cranial nerve involvement. It also emphasizes the need to consider spinal imaging when initial brain CT is inconclusive in patients presenting with acute neurological deficits. Early recognition of these clinical features is crucial, as prompt surgical intervention significantly improves neurological outcomes and reduces the risk of long-term disability.