The Mystery of Quadriparesis in a 15-year-old: A Diagnostic Challenge

Background: Spontaneous spinal epidural haematoma (SSEH) is a rare but potentially devastating condition, often mimicking functional neurological disorders, especially in young individuals without trauma or risk factors.Case presentation: A previously healthy 15-year-old boy presented with acute neck pain, initially attributed to musculoskeletal strain.He subsequently developed bilateral lower limb weakness and urinary retention over 12 hours, initially misdiagnosed as a dissociative sensory disorder.Progressive neurological deterioration prompted magnetic resonance imaging (MRI), revealing a cervical spinal epidural haematoma (C5-C7) with cord compression.Emergency decompression surgery was performed twice due to re-bleeding.Full neurological recovery was achieved, allowing him to attend his board exams before discharge.Conclusion: This case highlights the diagnostic challenges posed by SSEH, especially when early symptoms mimic benign or functional conditions.A high index of suspicion and early MRI imaging are critical when evaluating progressive neurological symptoms, even in the absence of trauma or bleeding risk factors.