Objective:

We present a rare case of iatrogenic left psoas hematoma following an unsuccessful lumbar puncture (LP) for suspected Acute Inflammatory Demyelinating Polyneuropathy with subsequent successful endovascular lumbar artery embolization.

Background:

Lumbar punctures (LPs), used for diagnostic and therapeutic purposes, are generally considered safe. While post-procedure headaches are common, severe complications, such as infections and local hemorrhage, are rare. Psoas hematoma, a potential complication, is infrequently reported in LPs.

Design/Methods:

N/A

Results:

We present the case of a 59-year-old obese female (body mass index of 33.3 Kg/m2) recently diagnosed with hypertension, presented with rapid onset paraplegia with associated sensory impairment. She underwent an LP to rule out Acute Inflammatory Demyelinating polyneuropathy (AIDP). Despite multiple attempts, the LP was unsuccessful, following which she complained of left flank pain and left hip flexion and knee extension motor weakness. She had hypotension and a significant decrease in hemoglobin level. Computed tomography scan confirmed the presence of a left psoas muscle hematoma. Although no active bleeding was found on arteriogram, empirical therapeutic embolization of left lumbar L4 artery was performed. This patient was managed within hours of symptom onset with early endovascular therapy avoiding the need of blood transfusion. 

Conclusions:

This case underscores the importance of prompt evaluation and management in LP-related complications, with need for maintaining vigilance for potential iatrogenic complications including significant soft-tissue hemorrhage.