Multiple intracranial epidural hematomas after lumbar puncture: Case report and review of the literature

BACKGROUND- Epidural hemorrhage can be associated with a rapid and fatal deterioration if not promptly treated. Epidural hematoma is usually associated with trauma; however, it has rarely been associated with several atraumatic conditions, including hemophilia, afibrinogenemia, severe thrombocytopenia, vascular malformations of the dura mater, and central nervous system infectious processes. Multiple intracranial epidural hemorrhages after lumbar puncture in the setting of coagulopathy have not been reported previously. REVIEW SUMMARY- Presented is a patient who suffered multifocal acute intracranial epidural hematomas after a diagnostic lumbar puncture. A 26-year-old woman with promyelocytic leukemia developed severe headaches while undergoing chemotherapy. After a lumbar puncture, the patient became unresponsive with a dilated pupil. Head computed tomographic scan demonstrated multiple epidural hematomas. Although the patient had immediate recovery of neurologic function after emergent evacuation, she died of sepsis related to immunosuppression. CONCLUSIONS- Early recognition of spontaneous epidural hematomas can result in a favorable neurologic outcome if prompt evacuation is performed. Physicians should be aware of the potential risk of this occurrence.

Duke Scholars

Author Dennis Alan Turner Neurosurgery