etiological factors for spinal epidural hematoma are tumors , anticoagulant therapy , coagulopathy , hypertension , arteriovenous malformations , and trauma . most common presentation is sudden back or neck pain followed by a motor or sensory dysfunction with or without urinary retention . complete neurological recovery is possible with early diagnosis and urgent surgery while delay in the treatment of this condition causes permanent neurological deficit . a previously healthy 14-year - old boy was admitted with a 15-day history of back pain , urinary retention , and weakness of both lower limbs . the patient noted a rapid increase of his symptoms after 2 days with complete loss of power and sensation in lower limbs . the patient was admitted in some local hospital and came to us after 2 weeks of onset of symptoms . there was no history of spinal trauma , systemic disease , anticoagulant usage , or coagulopathy . neurological examination revealed bilateral sensory disturbance of all modalities below the level of fourth dorsal vertebrae level and spastic paraplegia . t1- and t2-weighted magnetic resonance ( mr ) images revealed a mass lesion suggesting an epidural hematoma , extending from dorsal vertebrae d1 to dorsal vertebrae d6 , localized in the ventral spinal epidural space . fourth and fifth dorsal laminectomy with left partial facetectomy was performed , and an epidural clot was totally removed using microneurosurgical technique . during surgery , no vascular abnormality was observed , but no dural pulsation was evident at the end of the procedure . an mr sean of the spine was performed 10 days after the operation which showed complete removal of hematoma [ figure 2 ] . ( a ) t1-weighted magnetic resonance imaging dorsal spine sagittal cuts , ( b ) t2-weighted sagittal cuts , ( c and d ) t2-weighted axial cuts showing a ventral spinal epidural hematoma extending from d1 to d6 vertebra and displacing and compressing the cord posteriorly ( a and b ) t2-weighted postoperative magnetic resonance imaging dorsal spine sagittal cuts , ( c and d ) t2-weighted axial cuts showing laminectomy defect with complete evacuation of ventral epidural hematoma ventral sseh , as our case , is even rarer with only four previous cases reported in the literature . the most common clinical presentation is sudden back or neck pain followed by motor and sensory dysfunction with or without urinary retention . the neurologic deficits are dependent to the localization of hematoma , horner or brown - sequard syndromes may be noted . the progression of the symptomatology and clinical signs is usually very rapid , as in our case , although slower progression over a few days has also been reported . most common causes of spinal epidural hematoma are the use of anticoagulants , coagulopathies ( hemophilia and leukemia ) , and procedures such as a spinal tap or epidural anesthesia . most authors have contended that sseh arises from epidural venous plexus in the spinal epidural space . because of fluctuations in intrathoracic and intra - abdominal pressures after exercise or other maneuvers , reversal of blood flow may induce rupture of a delicate vein in the valveless epidural plexus . ct findings are similar to intracranial epidural hematoma showing hyperdense lenticular collection . mr imaging is the best examination for diagnosis and follow - up . the dura mater is visualized as curvilinear low signal , separating the hematoma from the cord . the hematoma is isointense or slightly hyperintense on t1-weighted images and heterogeneous on t2-weighted images within 24 h of onset . later , hematoma gives a high signal on both t1- and t2-weighted sequences . in the absence of any signs suggestive of vascular malformation on mr imaging , preoperative angiography is not essential and need not delay the surgical procedure , because the timing of the surgery , together with the preoperative clinical state , determines the quality of the clinical result . posteriorly placed hematoma can be easily removed by doing laminectomy but anteriorly placed hematoma needs good exposure and microneurosurgical techniques to prevent retraction injury to the cord . partial facetectomy can be done in dorsal spine to enhance exposure , and lateral corridor can be used to prevent thecal sac retraction . complete and partial neurological recovery has been described in approximately 50% and 44% of the patients , respectively . recovery was significantly better when decompression was performed within < 36 h of the onset of the neurological deficit . in the majority of cases with sseh , the mainstay of treatment will remain surgical decompression of the neural structures and removal of the hematoma . the decision for conservative treatment has to be based on the severity of the neurological deficit and on the clinical course . prognosis of the patient with sseh depends on the severity of the neurologic deficit on admission and interval from onset of initial symptom to surgery . early diagnosis and prompt surgery are crucial to achieve the best neurological outcome and delay in the diagnosis and treatment may cause permanent neurologic deficit