Ventral Spinal Epidural Hematoma Triggered by Self-Urinary Catheterization and the Role of Diffusion-Weighted Imaging in Early Detection

Spontaneous spinal epidural hematomas (SSEHs) are extremely rare and clinically recognized by sudden onset of severe neck pain and progressive neurological deficits. Ventral SSEH is particularly uncommon, accounting for less than 10% of SSEH cases. Early and accurate diagnosis is crucial, especially using magnetic resonance imaging (MRI). However, conventional MRI sequences occasionally exhibit unclear signal changes during the early stages of hemorrhage, which may be overlooked by clinicians unfamiliar with this uncommon disease. This report presents the case of an 81-year-old man who developed a cervical ventral SSEH during self-urinary catheterization. Diffusion-weighted imaging (DWI) was instrumental in identifying the hematoma, as it revealed a high signal ventral to the spinal cord, which was not immediately apparent on conventional MRI sequences. The patient experienced acute posterior cervical pain and neurological deficits, including lower extremity paralysis, which spontaneously resolved within hours. Follow-up imaging demonstrated the resolution of spinal cord compression. This case underscores the diagnostic value of DWI in identifying acute ventral spinal epidural hematomas, particularly when conventional imaging modalities fail to provide definitive results.