“Painless” spinal epidural hematoma during anticoagulant therapy

Severe back or radicular pain has previously been considered as the earliest and most prominent symptom in spinal epidural hematoma. In the patient described here, a "painless" spinal epidural hematoma developed during anticoagulant therapy. The absence of pain delayed recognition of the lesion and institution of therapy. The absence of pain is distinctively rare, but should not delay appropriate diagnostic procedures when other signs suggest the presence of a spinal epidural hematoma.