Abstract：
BACKGROUND: Multiple lumbar punctures have historically been a strategy to relieve headaches associated with idiopathic intracranial hypertension despite limited clinical evidence of long-term efficacy. Lumbar puncture is typically a straightforward procedure with minimal complications reported, however, serious complications can occur. Lumbar-puncture-related spinal hematomas are rare but can lead to irreversible paralysis.
METHODS: We report a case of a 28-year-old Caucasian woman who was treated with multiple lumbar punctures to manage headache, thought to be attributed to idiopathic intracranial hypertension. The patient developed a lumbosacral epidural hematoma following a lumbar puncture, which led to incomplete cauda equina syndrome. Multiple lumbar punctures had been the long-term management for the patient\'s chronic headaches associated with her diagnosis of idiopathic intracranial hypertension. She had no risks of an underlying coagulopathy. Following a lumbar puncture, she re-presented with lower back pain and bilateral paresthesia. Over the subsequent 48 hours, this progressed to urinary incontinence and saddle paresthesia. Imaging revealed an epidural hematoma, which was conservatively managed. She continued to report saddle paresthesia and urinary incontinence 7 months following the lumbar puncture. Between 1974 to 2022, our literature search found 41 case reports detailing lumbar-puncture-related spinal hematomas. It is an established but rare complication of lumbar puncture and there are limited studies looking at the incidence of its occurrence. Whilst coagulopathy has been found to be a risk factor, it is unclear if the gauge of the needle is relevant. Case evidence suggests there may be no significant difference in outcomes between surgical and conservative management of spinal hematomas. This case highlights that lumbar punctures can be invasive, with potentially serious complications. A lumbar puncture should therefore only be performed when clinically justified.
CONCLUSIONS: This case highlights a rare complication of lumbar puncture and emphasizes the importance of a risk-benefit discussion for each procedure. Spinal hematoma following lumbar puncture is a rare complication but with potentially devastating consequences. Within the setting of idiopathic intracranial hypertension, the evidence base for the long-term benefit of headache relief by repeat lumbar puncture is low.
METHODS: We report a case of a 28-year-old Caucasian woman who was treated with multiple lumbar punctures to manage headache, thought to be attributed to idiopathic intracranial hypertension. The patient developed a lumbosacral epidural hematoma following a lumbar puncture, which led to incomplete cauda equina syndrome. Multiple lumbar punctures had been the long-term management for the patient\'s chronic headaches associated with her diagnosis of idiopathic intracranial hypertension. She had no risks of an underlying coagulopathy. Following a lumbar puncture, she re-presented with lower back pain and bilateral paresthesia. Over the subsequent 48 hours, this progressed to urinary incontinence and saddle paresthesia. Imaging revealed an epidural hematoma, which was conservatively managed. She continued to report saddle paresthesia and urinary incontinence 7 months following the lumbar puncture. Between 1974 to 2022, our literature search found 41 case reports detailing lumbar-puncture-related spinal hematomas. It is an established but rare complication of lumbar puncture and there are limited studies looking at the incidence of its occurrence. Whilst coagulopathy has been found to be a risk factor, it is unclear if the gauge of the needle is relevant. Case evidence suggests there may be no significant difference in outcomes between surgical and conservative management of spinal hematomas. This case highlights that lumbar punctures can be invasive, with potentially serious complications. A lumbar puncture should therefore only be performed when clinically justified.
CONCLUSIONS: This case highlights a rare complication of lumbar puncture and emphasizes the importance of a risk-benefit discussion for each procedure. Spinal hematoma following lumbar puncture is a rare complication but with potentially devastating consequences. Within the setting of idiopathic intracranial hypertension, the evidence base for the long-term benefit of headache relief by repeat lumbar puncture is low.
摘要：
背景：尽管长期疗效的临床证据有限，但多次腰椎穿刺历来是缓解特发性颅内高压相关头痛的策略。腰椎穿刺通常是一个简单的过程，报告的并发症最少，然而,可能发生严重的并发症。腰椎穿刺相关性脊髓血肿很少见，但可导致不可逆的瘫痪。
方法：我们报告了一例28岁的白种人妇女，她用多次腰椎穿刺治疗头痛，被认为是由于特发性颅内高压。患者腰椎穿刺后出现腰骶硬膜外血肿，导致了不完全的马尾综合症.多次腰椎穿刺是患者慢性头痛与特发性颅内高压诊断相关的长期治疗方法。她没有潜在的凝血障碍的风险。腰椎穿刺后,她再次表现为下背部疼痛和双侧感觉异常。在接下来的48小时里，进展为尿失禁和鞍状感觉异常。影像学显示硬膜外血肿,这是保守管理的。腰椎穿刺后7个月，她继续报告鞍座感觉异常和尿失禁。在1974年至2022年之间，我们的文献检索发现了41例详述腰椎穿刺相关脊柱血肿的病例报告。这是一种既定但罕见的腰椎穿刺并发症，对其发生率的研究有限。虽然凝血障碍已被发现是一个危险因素，目前尚不清楚针头的规格是否相关。病例证据表明，手术和保守治疗脊柱血肿的结果可能没有显着差异。这个案例突出了腰椎穿刺可以是侵入性的,潜在的严重并发症。因此，只有在临床合理的情况下，才应进行腰椎穿刺。
结论：此案例突出了腰椎穿刺的罕见并发症，并强调了对每种手术进行风险收益讨论的重要性。腰椎穿刺后的脊柱血肿是一种罕见的并发症，但具有潜在的破坏性后果。在特发性颅内高压的背景下，重复腰椎穿刺缓解头痛的长期益处的证据基础较低.
方法：我们报告了一例28岁的白种人妇女，她用多次腰椎穿刺治疗头痛，被认为是由于特发性颅内高压。患者腰椎穿刺后出现腰骶硬膜外血肿，导致了不完全的马尾综合症.多次腰椎穿刺是患者慢性头痛与特发性颅内高压诊断相关的长期治疗方法。她没有潜在的凝血障碍的风险。腰椎穿刺后,她再次表现为下背部疼痛和双侧感觉异常。在接下来的48小时里，进展为尿失禁和鞍状感觉异常。影像学显示硬膜外血肿,这是保守管理的。腰椎穿刺后7个月，她继续报告鞍座感觉异常和尿失禁。在1974年至2022年之间，我们的文献检索发现了41例详述腰椎穿刺相关脊柱血肿的病例报告。这是一种既定但罕见的腰椎穿刺并发症，对其发生率的研究有限。虽然凝血障碍已被发现是一个危险因素，目前尚不清楚针头的规格是否相关。病例证据表明，手术和保守治疗脊柱血肿的结果可能没有显着差异。这个案例突出了腰椎穿刺可以是侵入性的,潜在的严重并发症。因此，只有在临床合理的情况下，才应进行腰椎穿刺。
结论：此案例突出了腰椎穿刺的罕见并发症，并强调了对每种手术进行风险收益讨论的重要性。腰椎穿刺后的脊柱血肿是一种罕见的并发症，但具有潜在的破坏性后果。在特发性颅内高压的背景下，重复腰椎穿刺缓解头痛的长期益处的证据基础较低.
