An 86-year-old male with atrial fibrillation presented with the acute onset of a spontaneous quadriparesis (i.e., upper extremities 2–3/5, lower extremities 5/5, diffuse hyperesthesia throughout the upper extremities, marked ataxia, and poor tandem gait). His medical history included idiopathic Parkinson’s disease of over 10 years duration. The patient’s medications included the anticoagulant dabigatran etexilate plus additional antiplatelet agents (i.e., clopidogrel and aspirin). His other medications included amiodarone, carbidopa-levodopa, and rasagiline. Laboratory values revealed a serum WBC 4.8 × 103/uL, Hgb 13.0 g/dL, platelets 111 × 103/uL, an elevated PT (PT 14.3 s), and PTT (PTT 65 s). The INR was, however, just 1.0. Of interest, the troponin level was normal (0.01 ng/mL). MRI sagittal imaging (i.e., could not tolerate complete sequences) demonstrated an expansile ventral epidural hematoma extending from C2 to T2 that resulted in significant cord compression. The signal within the clot was hypointense on T1 and hyperintense on the T2 sequences [ and ]. A flow void was also seen in the epidural space posterior to the C6-7 disc space. The patient’s medical management included stopping aspirin, clopidogrel, and dabigatran etexilate. After consulting with the hematology-oncology service, the patient was given idarucizumab, a direct monoclonal antibody inhibitor to dabigatran. In addition, he was started on intravenous dexamethasone 6 mg every 6 hours and gabapentin 100 mg 3 times daily. Within 2 weeks, the patient regained normal (i.e., his baseline) neurological function. The MRI obtained 1 month later (further confirmed complete resolution of the ventral epidural hematoma with no residual hemorrhage) [ and ].