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Intraspinal and intracranial hemorrhage after lumbar puncture

Anselm C W Lee1, Yu Lau, C H Li

  • 1Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China. aclee@graduate.hku.hk

Pediatric Blood & Cancer
|September 13, 2005
PubMed

Insights

Lumbar puncture (LP) can cause central nervous system bleeding in children with cancer, including spinal epidural hematoma and intracranial subdural hematoma. This risk exists even with normal platelet counts and does not always require surgical intervention.

Area of Science:

  • Pediatric Oncology
  • Neurology
  • Hematology

Background:

  • Children undergoing chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma are at risk for complications.
  • Lumbar puncture (LP) is a common diagnostic and therapeutic procedure in pediatric oncology.

Observation:

  • Four cases of central nervous system (CNS) bleeding (two spinal epidural hematomas, two intracranial subdural hematomas) occurred after LP in children receiving cancer chemotherapy.
  • Bleeding events were mostly asymptomatic or presented with headache/backache, without neurological deficits.
  • Platelet counts varied, with two patients showing thrombocytopenia (8 and 46 x 10(9)/L) at the time of LP, while others had normal counts.

Findings:

  • Lumbar puncture carries an uncommon risk of CNS bleeding in pediatric cancer patients.
  • Thrombocytopenia is not a universal finding in these cases.
  • All patients recovered without the need for surgical intervention.

Implications:

  • Clinicians should consider CNS bleeding as a potential complication of LP in pediatric cancer patients, distinct from postdural puncture headache (PDPH).
  • Careful patient selection and monitoring are essential, even in the absence of significant thrombocytopenia.
  • Non-surgical management appears effective for these rare bleeding events.

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