Spinal epidural hematomas most commonly occur spontaneously, with anti-coagulation/coagulopathy, disc hernia, vascular anomaly, Valsalva maneuver, and possibly hypertension.  Spinal epidural hematomas can also be post-traumatic (as in this case) or iatrogenic.

They typically extend over multiple levels and can be seen dorsal, ventral or circumferential to the thecal sac. These collections may be associated with neurological impairment from compression of the spinal cord or cauda equina, and necessitating surgical evacuation/decompression. 

Although best evaluated with MRI, spinal epidural hematomas should be sought for even on CT when spinal trauma is diagnosed. 

Case co-author: Rehana Jaffer, MD, FRCPC