Painless Spontaneous Spinal Epidural Hematoma Mimicking Acute Ischemic Stroke: A Case Report

AIM: Spontaneous spinal epidural hematoma is a rare neurological emergency. Its painless variant is particularly uncommon and can easily be misdiagnosed as acute ischemic stroke, especially in patients receiving anticoagulant therapy. This study aims to enrich the clinical recognition of painless spontaneous spinal epidural hematoma and emphasize its differential diagnosis from acute stroke in high-risk medicated patients.

Case presentation

We report a rare case of painless spontaneous spinal epidural hematoma mimicking acute ischemic stroke in a woman in her early 60s receiving anticoagulation and antiplatelet therapies. She initially presented with neck tightness and bilateral limb numbness without pain, followed by transient right hemiplegia and rapid neurological deterioration. Magnetic resonance imaging (MRI) revealed a C4–T2 cervical epidural hematoma causing severe spinal cord compression.