Intraspinal hematoma should be considered in patients with acute presentations and imaging with MRI is the 1st choice of investigation.

Pointers to hematoma instead of neoplasms are -

1. Differential signals in T2W, due to multiple bleeding components.
2. Ill defined borders of the lesion.
3. No post-contrast enhancement.
4. In some cases underlying causes of bleeding like dural AV fistula or AV malformations should be considered.

The patient was taken up for decompression surgery immediately after imaging and confirmed findings of hematoma and dural AV fistula. The hematoma was in epidural location. Coagulations of the AV fistula was undertaken.

 After the evacuation of the hematoma patient's motor response improved immediately.