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Pediatric post-dural puncture headache and paraplegia

Wouter I Schievink1, Marcel M Maya2, Rachelle B Taché1

  • 1Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Headache
|June 11, 2024
PubMed

Insights

A cerebrospinal fluid (CSF) leak from a lumbar puncture can cause paraplegia. Surgical repair of the dural tear effectively resolved symptoms in pediatric patients.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Medicine

Background:

  • Diagnostic lumbar punctures are common procedures in pediatric patients.
  • Cerebrospinal fluid (CSF) leaks can occur iatrogenically following lumbar puncture.
  • Delayed complications of CSF leaks, such as paraplegia, are rare but significant.

Observation:

  • Two pediatric patients developed paraplegia following diagnostic lumbar punctures.
  • Imaging revealed extensive extradural CSF collections.
  • Digital subtraction myelography identified ventral dural puncture holes as the source of the CSF leak.

Findings:

  • The CSF leaks were caused by ventral dural puncture holes, with the needle traversing the entire dural sac.
  • One patient experienced cortical vein thrombosis secondary to the CSF leak.
  • Surgical repair of the ventral dural defects resulted in prompt resolution of paraplegia in both cases.

Implications:

  • Iatrogenic ventral CSF leaks can lead to long-standing complications, including functional paraplegia.
  • Early identification and surgical management of ventral dural defects are crucial for favorable outcomes.
  • This highlights the importance of meticulous technique during lumbar punctures to prevent dural sac injury.

Keywords:
cerebrospinal fluidcortical vein thrombosisintracranial hypotensionpediatric headachepost‐dural puncture headache

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