2026 Volume 13 Pages 451-455
Spontaneous spinal epidural hematoma (SSEH) presents with back pain followed by myelopathy. Venous plexus disruption is common, and arterial bleeding is extremely rare. Here, we report a case of acute spontaneous spinal epidural hematoma that showed spot sign on computed tomographic angiography and was treated.
A 48-year-old woman with no medical history experienced unprovoked back pain and visited a local hospital, where she was placed under observation. Numbness gradually developed in both legs, and the patient visited our emergency room 5 hours after the onset of symptoms. Magnetic resonance imaging revealed spontaneous spinal epidural hematoma on the left ventrolateral side at the T4-6 level, and computed tomographic angiography showed a spot sign at T5-6. During the examination, the patient's paraplegia progressed, and she presented with bladder-rectum dysfunction. She was diagnosed with spinal shock and underwent emergency surgery 9 hours after the onset of symptoms. The hematoma was removed and the source of arterial bleeding was treated, generating a complete recovery.
In cases of acutely progressing paraplegic spontaneous spinal epidural hematoma, contrast-enhanced computed tomographic angiography is useful for identifying the source of bleeding, and in cases of arterial bleeding, emergency decompression and vascular ligation are useful.
