Spontaneous Thoracic Spinal Epidural Hematoma: A Case Report and Literature Review

Spontaneous spinal epidural hematoma (SSEH) is a rare but potentially devastating clinical condition characterized by hemorrhage within the epidural space. To date, approximately 300 cases have been reported worldwide, and the exact etiology remains unclear. Current evidence suggests that rupture of epidural arteriovenous vessels or preexisting arteriovenous malformations may contribute to the development of SSEH. This report describes a 72-year-old male patient who presented with acute-onset thoracic and back pain, accompanied by numbness and progressive weakness in both lower limbs over a 12-h period. Due to the rapid progression of neurological symptoms, the condition may be initially mistaken for cardiovascular disorders. Magnetic resonance imaging (MRI) revealed an epidural space-occupying lesion extending from the T7 to T9 vertebral levels, consistent with hematoma formation. Decompressive laminectomy and evacuation of the hematoma were performed 35 h after symptom onset. Within 1 week postoperatively, marked improvement was observed in motor function and sensory deficits of the lower extremities. This case highlights the severe neurological consequences associated with SSEH and emphasizes the necessity of maintaining a high index of clinical suspicion in patients presenting with acute back pain and rapidly evolving neurological deficits. Early diagnosis through prompt MRI assessment is crucial, and timely surgical intervention in cases of acute spinal cord compression can significantly improve clinical outcomes.