Dural tear from diagnostic lumbar puncture followed by long-term morbidity: a case report
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(2020) 2:36
Neurological Research and Practice
LETTER TO THE EDITOR
Open Access
Dural tear from diagnostic lumbar puncture followed by long-term morbidity: a case report Aleksander Fjeld Haugstvedt1* , Inger Birgitte Havsteen2 and Hanne Christensen3,4 Abstract Background: Lumbar punctures are performed in different medical settings and are a key procedure in the diagnosis of several neurological conditions. Complications are rare and generally self-limiting. There are no reports of symptomatic accumulation of fluid in the epidural space after lumbar puncture in adults and there are no studies on long-term outcome after post dural puncture headache (PDPH). Case: A lumbar puncture was performed in a 29 y.o. slender woman with unspecific symptoms to rule out neuroinfection. Next day MRI showed substantial accumulation of CSF in the epidural space from C2 to the sacrum dislocating the spinal chord in the spinal canal. The condition was ameliorated by epidural blood-patching. At 5 months she was still impaired by severe orthostatic headache. Conclusions: The only plausible explanation for the massive CSF leak was a dural tear occurring during multiple attempts of lumbar puncture. Anterior dislocation of the spinal chord due to CSF leak is not a recognised complication to lumbar puncture. This complication was followed by long-term disability in our case. The diagnosis can be made by MRI. A difficult procedure with several attempts and use of traumatic technique may increase risk of this complication. Keywords: Spinal puncture, Post dural-puncture headache, General neurology Lumbar puncture is a common diagnostic procedure in neurology, as well as emergency medicine and internal medicine. Post-dural puncture headache (PDPH) is a common complication; the drawn volume of cerebrospinal fluid (CSF) correlates with PDPH frequency [1]. Serious complications including infections and hematomas are considered rare [2]. PDPH is a clinical diagnosis based on a history of recent dural puncture, either intentional or accidental, and the presence of orthostatic headache. Diagnostic criteria for PDPH have been suggested [3]. The diagnosis requires no blood samples or radiological imaging. Bed rest, fluid therapy, caffeine, analgesics, and application of * Correspondence: [email protected] 1 Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark Full list of author information is available at the end of the article
epidural blood patch are used to ameliorate symptoms, which are expected to be short lasting (few days). Finally, surgical exploration and closure of the dural defect can be considered if symptoms are persistent [4–6]. Generally, evidence regarding treatment of PDPH is weak and patients are rarely seen by specialists. Epidural infections and hematomas present with symptoms raging from local back pain, through motor weakness and sensory deficit to paralysis. MRI of the spine can in most cases confirm the diagnosis [7, 8]. Symptomatic epidu
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