Spontaneous spinal epidural hemorrhage is a rare emergency. It is characterized by back pain with radicular radiation in the chest and extremities followed by progressive signs of cord compression. The exact etiology is unknown. Presented here is the case of a 34-year-old man who arrived in the emergency department with back pain, followed 20 minutes later by acute paralysis of both legs. Emergency laminectomy revealed an epidural hematoma with compression of the spinal cord. The man was discharged from the hospital seven days post-evacuation of the hematoma with a slightly unsteady but improving gait. The presenting symptoms, etiology, pathophysiology, differential diagnosis, and treatment of this unusual lesion are reviewed.