**1. Introduction**

Spinal epidural haematomas (SEH) occur from extra-dural bleeding, most commonly after trauma, epidural anaesthesia or operative intervention [1, 2]. These haematomas are rare but carry a significant risk of spinal cord or nerve root compression potentially resulting in permanent neurological dysfunction and death [3, 4].

Spontaneous spinal epidural haematomas (SSEH) occur without an obvious inciting event, although they may be associated with vascular malformations of the spinal canal. These haematomas are rare with a quoted incidence of approximately 0.1 cases per 100,000 population annually [5–7]. When they occur they often mimic other conditions such as cerebro-vascular accidents [8, 9], which may make them a difficult condition to diagnose, resulting in a delayed diagnosis and potentially mismanagement with anticoagulation therapy [9, 7, 10]. However, the consequences of SSEH can be devastating with progressive neurological decline, permanent cord injury and even death [3, 11, 12]. Thus, early and accurate diagnosis and management is essential to preserve neurological function and optimise the chance of recovery [13].

The aims of treatment in SSEH are to restore normal neurological function with minimal risk to the patient, however the method of achieving this remains uncertain [13]. Surgical decompression, typically through a partial or complete laminectomy or laminoplasty, allows direct decompression of the neural elements and evacuation of the haematoma but carries both anaesthetic and surgical risk. Less invasive options include radiologically guided aspiration of the haematoma, however this also carries

risks of neural injury and further bleeding, often without complete evacuation of the haematoma. Medical therapy with steroids and/or pro-coagulation therapy is aimed at reducing local swelling and preventing further bleeding but fails to remove the compressive effects of the haematoma. Similarly, embolisation of the bleeding vessel may prevent further bleeding, but fails to remove the haematoma. The treatment approach is therefore complex and depends on the patient's presentation. Three defined groups of patients where the management varies are adults, pregnant women and children.
