Teaching NeuroImages: Spontaneous spinal epidural hematoma with spot sign positivity

An 82-year-old man on warfarin for previous venous thromboembolism presented to the hospital with acute neck pain followed by rapidly progressive, asymmetrical incomplete quadriparesis. Craniocervical CT angiography (CTA) was performed (figure 1), which revealed a spot sign and hyperdense material in the cervical spinal canal. MRI confirmed extradural hematoma from C4-T1 (figure 2), and successful surgical management was achieved.