Spontaneous cervical epidural hematoma following persistent cough in a patient on dual antiplatelet therapy

• SSEH can occur spontaneously due to a persistent cough, particularly in patients on dual antiplatelet therapy. • Early MRI diagnosis and prompt surgical intervention are critical for favorable neurological recovery. • Conservative management is an option for select patients, but surgery is preferred in cases with progressive deficits. This case report highlights a rare but serious medical condition called spontaneous spinal epidural hematoma (SSEH) that occurred in a 57-year-old patient with a history of thromboembolic events and chronic cough while undergoing antiplatelet therapy. The patient presented with progressive paresis and hypoesthesia in the right upper extremity and required hematoma evacuation with posterior cervical decompression and fusion. Despite newly developed neurological deficits after surgery, the modified Rankin score (mRS) improved from 4 preoperatively to 2 at the 6-month postoperative follow-up. This case underscores the importance of considering acute spinal hematoma in patients on antiplatelet therapy who present with acute neurological deficits and chronic cough and highlights the need for prompt diagnosis and appropriate management to prevent potential morbidity and mortality.