Related Experiment Video
Updated: May 11, 2026
10:02
A Battery of Motor Tests in a Neonatal Mouse Model of Cerebral Palsy
Published on: November 3, 2016
24.2K
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
Summary
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.
Related Concept Videos
01:22Bacterial Meningitis I: Introduction
Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
01:14Spinal Cord Injury ll: Pathophysiology
Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
01:25Secondary Spinal Cord Injury llI: Pathophysiology
Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...