Spontaneous spinal epidural hematoma is an uncommon cause of cord compression. Although there have been some risk factors reported, no one has proved to have a causal relationship. Some patients even had no significant risks found. Accurate diagnosis in early stages is difficult without high suspicion. Magnetic resonance imaging is the main diagnostic modality once clinically suspected. As the diagnosis established, early surgical decompression remains the major treatment. Conservative treatment should only be considered in the patient with rapid and constant improvement of neurological deficits.