A 75-year-old woman on long-term anticoagulation presents with rapidly progressive bilateral leg weakness, urinary retention, and a sensory level at T8 over 48 hours. MRI reveals a posterior epidural mass from T6 to T9 that is compressing the spinal cord. What is the most likely diagnosis?

• A Spinal epidural abscess
• B Epidural lipomatosis
• C Metastatic epidural cord compression
• D Spinal epidural hematoma ✓

Explanation

Spinal epidural hematoma is a neurosurgical emergency most commonly associated with anticoagulant therapy, coagulopathy, or recent spinal procedure. It presents with rapidly progressive cord compression over hours to days. MRI shows a biconvex epidural collection. Spinal epidural abscess typically has fever, leukocytosis, and subacute progression. Metastatic compression is slower and linked to known malignancy. Lipomatosis is indolent.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.