Spontaneous epidural haematoma with spinal cord compression in pregnancy - A case report

Spontaneous epidural haematomas are rare, and few cases have been reported in pregnancy. Frequently with back pain, and rapidly progressing neurological changes where spinal cord compression is present, magnetic resonance imaging (MRI) is the gold standard for diagnosis. Management generally involves prompt surgical decompression of the spinal cord. Limited access to specialist care and imaging in rural areas is a barrier to timely diagnosis and treatment. This case report outlines the diagnosis and management of a woman in her mid-twenties, presenting at 38 weeks of gestation to a rural hospital with back pain and lower limb weakness. MRI revealed spinal cord compression from an epidural cystic mass, suspected to be a haematoma. She was airlifted to a tertiary centre for an emergency caesarean section and subsequent laminectomy. Histopathology suggested an underlying arteriovenous malformation as the most likely cause. This case highlights the diagnostic and management challenges of spontaneous epidural hematomas in pregnancy, particularly in resource-limited rural environments.