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Department of Neurosurgery, Haseki Training and Research Hospital, Istanbul, Turkey Spontaneous spinal epidural hematoma is a rare emergency. The exact etiology is unknown. A 60-year-old woman arrived at the emergency department with back pain, followed 20 minutes later by acute paralysis of both legs. The initial magnetic resonance image (MRI) showed a spinal epidural hematoma extending from T-1 to T-12, with compression of the thoracic spinal cord. Emergency right hemilaminectomy (ten levels) revealed an epidural hematoma with compression of the spinal cord. The case was discharged from the hospital on the seventh post-operative day with a slightly unsteady but improving gait.This case is unique as it extends to T-1 and T-12. The presenting symptoms, etiology, pathophysiology, differential diagnosis, and treatment of this unusual lesion are reviewed. Keywords : Thoracic spinal epidural hematoma, magnetic resonance imaging, paraplegia