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Primary epidural hematomas or “hematorrachis” are rare and less frequent in the lumbar region. It presents with acute onset of severe back pain and rapid development of signs of compression Objective: To report a case of lumbar extradural spontaneous hematoma with acute paraparesis. Case Report: A 65 year old male presented with acute back ache of 2weeks duration with Radicular pain and numbness of both feet. He had progressive asymmetrical weakness of the lower extremities without bowel/bladder involvement and inability to walk.Radiograph of spine shows Grade 1 listhesis of L4-L5.MRI of LS Spine s/o synovial cyst at L2-L3 level.Left Facet joint arthropathy L2-L3. Patient underwent L2 laminectomy with removal of synovial cyst and hematoma Results: The patient had motor improvement of grade 3 power in hip and knee flexors and EHL AND EDL.3 months follow up showed grade 4 of all lower limb muscles with sensory numbness present on L3-L4 and L4-L5. Conclusion: Spontaneous spinal extradural hematoma should be suspected in any patient who complains of local or referred spinal pain associated with acute limb weakness, sensory deficits, with or without cauda equina symptoms. Case Report Introduction : Primary epidural hematomas or “hematorrachis” are rare and less frequent in the lumbar region. It presents with acute onset of severe back pain and rapid development of signs of compression of cord. Case report : A 65 year old male presented with acute back ache of 2weeks duration with Radicular pain and numbness of both feet. He had progressive asymmetrical weakness of the lower extremities without bowel/bladder involvement and inability to walk. No constitutional symptoms/ trauma/systemic illness. He was a known alcoholic and smoker. On evaluation of the spine no deformity and paraspinal region normal. Neurology : Upper limbs :normal, Straight leg raising test:bilateral free, Lower limbs :hip and knee -3/5,Ankle dorsiflexion-0/5, Plantar flexion1/5,Toes-1/5. Sensations were reduced over L3-L4,L5-S1 dermatome bilaterally. Deep tendon reflexes were absent and Bilateral plantar reflexes were equivocal. Investigations : Blood investigations: Bleeding profile is normal. Liver function tests are normal. Radiograph of spine shows Grade 1 listhesis of L4-L5.MRI of LS Spine s/o synovial cyst at L2-L3 level. Left Facet joint arthropathy L2-L3. Treatment : Patient underwent L2 laminectomy with removal of synovial cyst and hematoma. The synovial cyst located on the left facet joint was removed. A large hematoma measuring about 3x4cm was present extradural compressing the spinal cord with adhesion over the dura was seen. A brownish red mass dorsally extending from L1 to L2 compressing the dura & cord was present. There was no 33 Nitte University Journal of Health Science LUMBAR EXTRADURAL Deepak Hegde NUJHS Vol. 2, No.3, September 2012 ISSN 2249-7110 , Access this article online Quick Response Code active bleeding and no osseous involvement .The material was sent for biopsy. Histopathology shows hematoma, fibrous tissue and no evidence of tumour or synovial cells. SAGITAL IMAGES L2-L3 T2 TRUFI AXIAL IMAGES

LUMBAR EXTRADURAL SPONTANEOUS HEMATOMA WITH ACUTE PARAPARESIS