Acute spinal epidural hematoma may occur spontaneously with no apparent or only trivial antecedent cause. Bleeding may also occur secondary to trauma, spinal surgery, angioma, vascular malformation or coagulopathies, most particularly anticoagulant therapy. The hemorrhage generally occurs at the level of the spinal cord with sudden symptoms of focal and then radicular pain leading to paresis or paralysis. Chronic encapsulated epidural hematoma can occur at the level of the cauda equina, but this is even less common. The characteristic signs and symptoms, together with early myelographic demonstration of varying degrees of epidural block, will lead to appropriate diagnosis and prompt treatment.