SPINAL HEMORRHAGE Spinal epidural hematoma is a rare cause of symptomatic spinal cord compression Spontaneous, or nontraumatic, spinal epidural hematomas are seen in association with congenital or acquired bleeding disorders, hemorrhagic tumors, spinal AVMs, following lumbar puncture or instances of increased intrathoracic pressure MRI of the spine is the definitive diagnostic measure for establishing the presence of spinal epidural hematoma ( Fig 122.5 ) Decompression of the spinal cord is the key procedure for improving patient outcome Treatment outcome was favorable for patients with incomplete preoperative sensorimotor deficit, and recovery was significantly better when decompression was performed within 36 hours in patients with complete deficits and within 48 hours in patients with incomplete deficits There are advocates for conservative management in a very select patient population: those with no or mild deficits; those that demonstrate early, rapid, and progressive improvement in neurologic function within the first 24 hours despite an initial severe neurologic deficit; or those with small or noncompressive spinal epidural hematoma