Vertebral hemangiomas are common neoplasms of the spine and usually considered benign. They are usually asymptomatic and incidentally detected. A rare subset of them, referred to as aggressive hemangiomas, can be symptomatic presented with pain and neurological symptoms. The current study presented a case of a 27-year-old female with a four-month history of pain in thoracic spine and neurological involvement of the lower limbs for three weeks before the visit. Further investigations with computed tomography (CT) scan and magnetic resonance imaging (MRI) showed aggressive hemangioma in T4 vertebra with cord compression. The patient underwent laminectomy of T4, posterior fixation of T2-T6 and vertebroplasty. Final pathologic diagnosis after surgery confirmed the diagnosis of vertebral hemangioma. One month after surgery, the patient's motor symptoms and three months later, sensory symptoms were resolved.