PURPOSE: To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. MATERIALS AND METHODS: The MR and clinical findings in six patients (M:F=4:2;adult:child=3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogeneous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. RESULTS: The epidural lesion involved between three and seven vertebrae (mean: 4.5), and relative to the spinal cord was located in the posterior-lateral (n=4), anterior (n=1), or right lateral (n=1) area. The hematoma was isointense (n=1) or hyperintense (n=5) with spinal cord on T1-weighted images, and hy-pointense (n=2) or hyperintense (n=4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=4), spastic cerebral palsy (n=1), or unknown (n=1). CONCLUSION: Because of the lesion's characteristic signal intensity, MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma.