We present a case of massive spinal epidural hematoma with an atypical presentation characterized by unilateral, isolated motor deficit in the right lower extremity on postoperative day 2 after Collis-Nissen fundoplication and a T7-8 epidural for postoperative pain. The epidural had been placed in the preoperative theater before surgery. Subcutaneous unfractionated heparin was initiated 18 hours later on postoperative day 1 with 3 times daily dosing. The patient also received 3 doses of ketorolac starting 10 hours after epidural placement. Symptoms were first reported on postoperative day 2, 37 hours after epidural placement. Thoracic magnetic resonance imaging showed an epidural hematoma extending from T2 through T12, requiring emergent decompression and evacuation. The patient made a complete recovery without any resultant neurologic deficit.