Spontaneous spinal epidural haematoma with spontaneous symptom remission

A man in his 60s presented with spontaneous acute back pain and progressing paralysis in the lower extremities. A ruptured aortic aneurysm or dissection was suspected, but CT angiography and MRI showed a spontaneous spinal epidural haematoma (SSEH) from the cranio-cervical junction (C0) to the sixth thoracic vertebra (Th6). The patient was scheduled for acute decompressive surgery, but the symptoms spontaneously remitted. He was observed for 3 days with none of the symptoms reappearing. An MRI 1 month later showed full haematoma reabsorption. In patients without previous trauma and who are on antiplatelet/anticoagulant treatment, acute back pain and limb weakness can be a sign of an SSEH. Conservative management may be appropriate for patients with resolving or minimal symptoms, but it must include close observation for neurological deterioration. If surgery is required, it should be performed within 12 hours of symptom debut to reduce the risk of later neurological deficits.