Spontaneous spinal epidural haematoma is a rare condition with serious long- term effects. It has no proven causes but is associated with use of blood thinners, coagulopathies, underlying vascular malformations or tumours, and pregnancy. This is a case report of a 57-year-old woman with an atypical presentation, where an intracranial condition was suspected. The case is presented to increase awareness of the condition as a differential diagnosis, when stroke or subarachnoid haemorrhage is ruled out, and how important it is to refer these patients to an acute spinal MRI to avoid further neurological deterioration.