Spontaneous Spinal Epidural Hematoma Presenting as an Acute Stroke Mimic: A Diagnostic Challenge

Given the limited time window (typically less than 4.5 hours from the last known well time) during which thrombolysis can be administered for acute ischemic stroke, accurate diagnosis and the efficient exclusion of contraindications and mimics are essential. One such mimic is that of spontaneous spinal epidural hematoma (SSEH), where diagnosis can be challenging, especially without an MRI. In this report, we describe a case of a patient who presented within the window for thrombolysis with a sudden onset of neck pain and right sensorimotor symptoms mimicking an acute cerebral infarction, who was found to have SSEH. High clinical suspicion with careful review of available neuroimaging (CT angiogram) led to prompt diagnosis and hence avoided administration of antithrombotic agents, which could have been detrimental.