Spinal epidural hematoma (SEH) is an uncommon cause of acute cauda equina syndrome. Most of these hematomas are caused by trauma, anticoagulation therapy, and vascular anomalies or occur following spinal epidural procedures and, rarely, spinal surgery. Spontaneous SEH is an extremely rare occurrence. The incidence of symptomatic postoperative SEH is 0.1 to 3%. Clinical evaluation is the most important tool in the early diagnosis of SEH. Once the disease is suspected clinically and confirmed on diagnostic imaging, emergency evacuation of the lesion should be performed. Prognosis depends on the rate of development of symptoms, interval to surgery, level of spinal involvement, and degree of neurological deficit.