• J L Sánchez-Menoyo, J Ruiz-Ojeda, A Martínez-Arroyo, J C García-Moncó, M Aduna-De Paz, and I Vicente-Olabarría.
• Servicio de Neurología, Unidad de Galdakao, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, España. joseluis.sanchezmenoyo@osakidetza.net
• Rev Neurol. 2009 Apr 16;48(8):418-20.

IntroductionSpinal cord hematoma is a serious and feared complication of lumbar puncture. We here describe two patients who developed a spinal cord hematoma following diagnostic lumbar punctures.Case ReportsCASE 1: a 22-year-old male with a syndrome of cerebrospinal fluid hypotension, with normal coagulation parameters, underwent a traumatic, diagnostic lumbar puncture followed, a few hours later, by back pain irradiated to the legs. MRI showed the presence of a subdural hematoma from the lower dorsal region to the sacral region. A conservative approach, without surgery, was decided and he showed a complete recovery. CASE 2: a 69-year-old woman underwent a diagnostic lumbar puncture for the study of recent-onset headache with tinnitus and unstable gait. Puncture was traumatic and cerebrospinal fluid was normal. A few hours later, she complained of back pain and sciatica, and examination revealed a bilateral Lassegue sign. She required urinary catheterization. MRI showed an epidural hematoma from the T10 vertebra to the sacral area. Her outcome with a conservative approach was also excellent.ConclusionsSpinal cord hematomas can occur after a traumatic lumbar puncture in people without coagulation disorders or any other predisposing factor. Although surgery has been traditionally advocated in these cases, a conservative approach is an option when symptoms are mild and a close follow-up is possible.

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