Lumbar puncture complicated by spinal epidural hematoma in a child with leukemia

Abstract

Key Clinical MessageWe report a case of spinal epidural hematoma (SEH) preceded by diagnostic lumbar puncture (LP) in a 5-year-old boy with acute lymphoblastic leukemia. MRI confirmed the presence of SEH between T7 and L5 levels, but the patient showed fast recovery during the next hours and conservative management was elected.

Safety of lumbar punctures in patients with thrombocytopenia

“…In fact, a recent systematic review failed to identify any haemorrhagic complications among observational studies of paediatric patients . There are, however, rare published case reports of thrombocytopenic children developing haemorrhagic complications following LP, with symptoms ranging from transient paraparesis to quadriplegia necessitating immediate surgical intervention . These case studies included patients with thrombocytopenia of varying degrees (16 × 10 9 /l, 27 × 10 6 /l, 42 × 10 9 /l), with the latter two patients receiving pre‐LP platelet transfusions after the reported platelet count and prior to the LP.…”

Central Nervous System Hemorrhage Following Lumbar Puncture for Intrathecal Chemotherapy in a Pediatric Oncology Patient

“…The authors found only five pediatric cases reported in the literature when using the search words "hemorrhage" or "hematoma" and "lumbar puncture" and "pediatric". These cases are summarized in Table 1 [7,9,[13][14][15]. Of these, the one that is most similar to the case reported herein is a 12-year-old boy with ALL and thrombocytopenia (platelet count 42,000/µL) who underwent a diagnostic LP [15].…”

“…During the perioperative period, it is generally recommended that the platelet count be greater than 100,000/µL for the elective performance of regional anesthesia; however, lower thresholds have been suggested for diagnostic and therapeutic LP in oncology patients [4,5]. The importance of such issues is illustrated by anecdotal case reports of hemorrhagic complications (spinal and epidural hematomas) after LP in patients with thrombocytopenia [5][6][7]. We report a 3-year-old child with acute lymphoblastic leukemia (ALL) and associated thrombocytopenia who developed spinal and intraventricular hemorrhage following an LP for the administration of intrathecal chemotherapy.…”

Spontaneous intramedullary hematoma and leukemic deposit in spinal cord causing acute onset paraplegia in a child with acute lymphoblastic leukemia

“…Even rarer is intramedullary bleed or infiltration. Doing a lumbar puncture in the setting of hyperleukocytosis or thrombocytopenia have inadvertently resulted in an iatrogenic hematoma leading to paraplegia . Children with malignancy and back pain with radiation to limbs should be considered to have spinal cord compression until proven otherwise.…”