Thoracic Spontaneous Spinal Epidural Hematoma in a Young Adult: A Case Report

Spontaneous spinal epidural hematoma (SSEH) is an uncommon condition that may present with acute back pain and neurological deficits. Prompt diagnosis and timely intervention are important to optimise neurological recovery. A 21-year-old female presented with a 5-day history of back pain associated with right lower limb weakness, gait instability, and bilateral foot numbness. Clinical examination demonstrated reduced muscle power (4/5) in the right lower limb and an ataxic gait. Magnetic resonance imaging (MRI) revealed a posterior epidural hematoma extending from T6 to T8 with significant spinal cord compression and cord oedema. The patient underwent urgent T6-T8 decompressive laminectomy and evacuation of the hematoma. Intraoperatively, no vascular malformation was identified. Histopathological examination demonstrated an organizing hematoma without evidence of vasculitis or malignancy, and subsequent investigations excluded coagulopathy and autoimmune disorders. Postoperatively, the patient achieved complete neurological recovery with restoration of full muscle power. At one-year follow-up, she had returned to her premorbid functional status, and repeat MRI showed no recurrence, with only mild residual cord signal changes consistent with gliosis. SSEH should be considered in patients presenting with acute back pain and neurological deficits, even in the absence of identifiable risk factors. Early recognition, MRI evaluation, and timely surgical decompression can result in favourable neurological outcomes.