Objective:

To describe a rare complication of developing symptomatic epidural cerebrospinal fluid (CSF) collection following a lumbar puncture (LP) and to outline our approach in aiding this patient

Background:

Design/Methods:

NA

Results:

A 35-year-old female with history of nephrolithiasis and recurrent urinary tract infections presented to an outside hospital with flank pain and was diagnosed with pyelonephritis. During her admission, she developed meningismus and low back pain prompting a Lumbar Puncture (LP) to rule out meningitis. Within two hours post LP, she reported of excruciating back pain radiating from neck to lower back, weakness of all extremities (right>left), and paresthesia, predominantly in the upper limbs. During this time, she remained ambulatory with preserved bowel and bladder function. Her symptoms fluctuated but re-appeared in a similar pattern. MRI of the cervical and thoracic spine with and without contrast revealed concern for a ventral cervical enhancing epidural collection between cervical and lumbar spine as well as a cervicothoracic and thoracic dorsal non-enhancing T2 isointense to CSF compressive collection with near complete loss of intradural CSF space and cord deformation. Differentials included CSF leak versus hemorrhage.  Given the waxing and waning nature of her clinical picture with progressive weakness, multidisciplinary discussions with neuroradiology, neurosurgery, neurocritical care led the decision for surgical intervention. The patient underwent skip laminotomies of cervical, thoracic and lumbar spine. Intraoperatively, vascular engorgement was noted in cervical spine and a vascular membrane in the thoracic spine; thoracic epidural tissue was negative for infection or neoplasm, and microbiological cultures were negative. Post-operatively MRI of the spine showed resolution of epidural CSF collection and the patient significant improvement in paresis and  paresthesia. 

Conclusions: