A spine full of surprises: spontaneous spinal epidural hematoma presenting with acute non-traumatic paraparesis

Spontaneous spinal epidural hematoma (SSEH) is a rare but potentially catastrophic neurological emergency that can present with acute non-traumatic paraparesis and requires rapid diagnosis to prevent permanent disability. A 40-year-old male truck driver with no comorbidities presented with sudden onset bilateral lower limb weakness of 10–12 hours duration. Neurological examination revealed paraparesis with preserved upper limb function and a sensory level at T2. Magnetic resonance imaging of the thoracic spine demonstrated a biconvex epidural hematoma at the T1–T2 level causing significant spinal cord compression with early myelopathic changes. SSEH is often idiopathic, though transient increases in venous pressure due to activities such as heavy exertion or deceleration may contribute. Thoracic involvement, though less common, can result in severe neurological deficits. MRI is the diagnostic modality of choice, and early recognition is essential for timely intervention and improved outcomes. SSEH should be considered in patients presenting with acute non-traumatic paraparesis. Prompt imaging and diagnosis are crucial to prevent irreversible neurological damage.