Spontaneous cervicothoracic epidural misinterpreted as transient ischemic attack (TIA)

BACKGROUND: The acute onset of a spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of spinal cord compression. Early diagnosis and treatment are critical to avoid significant residual postoperative neurological deficits. CASE DESCRIPTION: A 15-year-old male presented with the sudden onset of a hemiparesis which recovered (4/5 weakness). The brain MR was negative, but spinal MRI revealed a dorsolateral extradural lesion extending from C7 to D1. At surgery, this proved to be a hematoma that we readily removed. CONCLUSION: Spontaneous epidural hematomas are rare. They should be diagnosed promptly with MR, and typically warrant urgent/emergent surgical excision. Further, cases of SSEH resulting in hemiparesis may occasionally be misdiagnosed as attributed to a stroke or transient ischemic attack.