Acute spinal epidural hematoma is a rare condition that requires urgent diagnosis and neurosurgical decompression. We reported a 47-year-old woman with diabetic neuropathy and cerebral vascular disease, who was presenting with acute spinal epidural hematoma involving the posterior aspect of entire thoracic and lumbar spine. Diabetic neuropathy delayed the diagnosis and initiation of treatment by leading to the absence of the typical pain. This clinical entity is exceptional for its excessive hematoma involving the entire thoracic and lumbar spine. The CT and MR imaging findings were presented with the review of literature.