Computed tomographic detection of a spontaneous cervical spinal epidural hematoma in a patient without overt neurological deficits

Spontaneous spinal epidural hematoma (SSEH), with an annual incidence of 0.1 per 100 000 individuals, typically presents with acute spinal pain followed by neurological deficits. We describe the case of a 73-year-old woman who presented with acute posterior neck and back pain without overt neurological deficits. While contrast-enhanced computed tomography (CT) was primarily performed to exclude aortic dissection, it played a critical role in incidentally identifying a hyperattenuating epidural lesion, which was subsequently confirmed as a dorsal cervical epidural hematoma by magnetic resonance imaging. Given the patient’s stable neurological condition, conservative management was adopted, resulting in complete recovery without sequelae. This case underscores that SSEH may manifest solely as pain and that CT, even when performed to exclude other vascular emergencies, can provide an incidental yet critical initial diagnostic clue, facilitating timely diagnosis and appropriate management.