Spinal epidural hematoma can occur spontaneously or as a secondary condition and it represents less than 1% of space-occupying lesions within the spinal canal. The incidence of spontaneous epidural bleeding is estimated to be 0.1 cases per 100,000 populations per year. Typical clinical manifestations include acute onset of back pain, sometimes associated with radicular paresthesia and signs of spinal cord compression in some cases. The clinical presentation with hemiparesis is rare, and it may hinder the diagnosis, especially in emergency situations. The purpose of this article is to present a clinical case of acute epidural hematoma with atypical clinical presentation, followed by literature review of spinal epidural hematoma.