An oculomotor palsy developing immediately after a spinal tap in a 6-year-old child

Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update

INTRODUCTION

Although lumbar puncture (LP) is a relatively straightforward procedure and is usually associated with low morbidity, rare and significant neurological complications can occur. Intramedullary spinal cord abscess (ISCA) after lumbar puncture is one of these serious complications; however, this complication has not yet been reported in children.

CASE REPORT

After 27 days in another medical facility, a 1-year-old girl was admitted to our hospital with a diagnosis of fever of unknown origin. Prior to the second admission, she had undergone multiple traumatic LP attempts. The patient was referred to our institution with progressive and ascending weakness. Three days later, this weakness involved all of the patient's four limbs. A LP was performed and showed purulent cerebrospinal fluid (CSF). An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary lesion extending from the T2 to L3 level. Broad-spectrum antibiotics and steroids were administered to the patient, and a T2-L3 laminectomy was performed. The postoperative course was uneventful, but a neurologic deficit, including lower limb paralysis, remained.

CONCLUSION

The index of suspicion for a pyogenic infection of the intramedullary space should be higher if progressive flaccid paralysis develops within a few days after a lumbar procedure. Nevertheless, the diagnosis may be challenging due to the rarity of this condition. Any misdiagnosis or delay of adequate treatment may lead to unfavorable outcomes.

Symptomatic spinal epidural CSF collection after lumbar puncture in a young adult: case report and review of literature

Lumbar puncture is a very common neurological diagnostic procedure which is associated with minimal risk. Epidural cerebrospinal fluid (CSF) collection can occur after puncture of the dura from extravasation of CSF from the thecal sac. On rare occasions, the epidural collection can be large enough to cause neurological dysfunction. The epidural fat has less fibrous stroma in children compared to adults, and it is postulated that this facilitates the dissection of CSF along epidural space. We report a rare case of a large symptomatic spinal epidural CSF collection shortly after lumbar puncture presenting with severe leg pain. The patient recovered fully within 48 h with bed rest and analgesia, and repeat imaging 1 month later showed good resolution of the epidural collection. Review of the literature revealed that epidural CSF collections resolve with conservative measures without the need for surgical intervention even in the setting of significant neurological symptomatology.