Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture

Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the needle puncture site, SSH may result in permanent neurologic deficits if not properly treated within a short period of time. An otherwise healthy 43-year-old female with no predisposing factors presented with fever and headache. Diagnostic lumbar puncture was performed under suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypoesthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deteriorated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy and hematoma removal. The patient's condition improved after the surgery from a preoperative motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 5/5) 3-month postoperative. The patient was discharged with no neurologic deficits. Critical complications such as SSH can be fatal. Therefore, a patient undergoing lumbar puncture must be carefully observed. A hematoma that convincingly compresses the spinal cord or cauda equina on imaging results requires early surgical decompression and hematoma removal.