Acute spontaneous spinal epidural hematoma--a life-threatening emergency.

Since Jackson reported the first case of Spinal Epidumi Haematoma (SSEH) in 1869 , some 250 cases have appeared inthe literature. We report the first case of SSEH that showed good recovery offunctioneven after complete tetrapelgia and respiratory arrest, emphasizing the favourable outcome of surgical decompression. There have been repoits of spontaneous resolution of the condition and recovery without surgical decompression. Based on these reports conservative (non-• operative) management has been advocated as a valid therapeutic option for some of these cases. Biphasic nature of the clinical course in our case (temporaiy resolution followed by relapse and rapid progression), also previously reported by others, makes conservative management of apparently resolving cases risky and inappropriate. Critical review of the reports of conservatively treated SSEH shows that the indications for nonoperative management of this condition are vezy limited and delay in surgical decompression can be catastrophic. Early surgical treatment of the condition confers marked prognostic advantage and conservative management, even in apparently resolving cases, should be discouraged.