Spontaneous Development and Resolution of Cervical Epidural Haematoma: a Case Report

Spontaneous cervical epidural haematoma (CEH) is a rare neurologic emergency that can lead to catastrophic and irreversible neurological deficits. Considering the poor prognosis, it must always be ruled out by magnetic resonance imaging (MRI) in patients presenting with acute onset of neurological deficits and if found present, must be intervened at the earliest. Here, we report a 72-year-old female who presented to us with acute onset of neck pain associated with progressive quadriparesis that developed over 3 h. MRI clearly revealed an epidural haematoma spanning cervical spinal levels C3–C5. Intravenous dexamethasone was administered, and emergency surgery was planned. Surprisingly, on subsequent pre-operative assessment, her neurological status improved. MRI was repeated 3 days later which revealed spontaneous complete resolution of the haematoma. She was back to her full function in 3 months. Ideally, emergency surgical laminectomy, decompression and draining of the haematoma are the first line of management. However, despite the extensive CEH and significant neurological impairment, our patient recovered spontaneously. Since, prognosis is inversely associated with time-to-treatment, the earlier the resolution of hematoma, it is better for the patient to not end up with irreversible neurological deficits. Given the rarity of such spontaneous resolution, surgical intervention should always be considered.