Cerebral venous thrombosis after lumbar puncture and intravenous high dose corticosteroids: A case report of a childhood multiple sclerosis

The association between cerebral venous thrombosis (CVT) and multiple sclerosis (MS) has already been reported in several adult patients with clinically definite MS, in a suspected relation to i.v. corticosteroids or previously performed lumbar puncture (LP). We are reporting a case, which is, to our knowledge, the first one concerning a child patient with a MS, who developed multiple CVT after LP and during high-dose i.v. corticosteroid. Our conclusions are that the sequence LP followed by high dose corticosteroids may be a contributory factor for the development of CVT when associated with other risk factors.     

Subdural hematoma after lumbar puncture: two case reports and review of the literature.

Two cases of intracranial subdural hematoma following lumbar puncture are presented. A review of all previously reported cases shows that subdural hematoma after lumbar puncture is a rare but serious complication. The pathogenesis of subdural hematoma after lumbar puncture is probably related to that of post lumbar puncture headache. Application of an epidural blood patch may therefore be a safe way not only to treat typical post lumbar puncture headache but also to prevent subdural hematoma after lumbar puncture.     

Acute thoracic epidural hematoma following spinal manipulative therapy: case report and review of the literature

Spinal epidural hematoma is a rare complication of chiropractic manipulation. This study reports a case of thoracic spinal epidural hematoma following spinal manipulative therapy in the absence of predisposing factors. The effectiveness and safety of chiropractic treatment in chronic spinal pain and a literature review are also presented.     

Combined transfrontal and endonasal endoscopic surgery of epidural abscess following frontal sinusitis. A case report

A large epidural abscess secondary to frontal sinusitis in a previously healthy 19-year-old man was successfully treated with a small eyebrow incision using combined transfrontal and endonasal endoscopic technique. The abscess was resolved with concomitant pneumatization of the paranasal sinuses. The present case illustrates the promising use of endoscopy in the merging fields of neurosurgery and otorhinolaryngology.     

Combined transfrontal and endonasal endoscopic surgery of epidural abscess following frontal sinusitis. A case report

Abstract

A large epidural abscess secondary to frontal sinusitis in a previously healthy 79-year-old man was successfully treated with a small eyebrow incision using combined transfrontal and endonasal endoscopictechnique. The abscess was resolved with concomitant pneumatization of the paranasal sinuses. Thepresent case illustrates the promising use of endoscopy in the merging fields of neurosurgery and otorhinolaryngology. [Neural Res 1999; 21: 229-232]     

Spinal subdural hematoma following cranial surgery: a case report and review of the literature

Spinal subdural hematoma (SDH) following a cranial surgery is extremely rare. We described a 26-year-old patient who developed an SDH at L3-S1 level after the excision of intraventricular meningioma. He was surgically treated with an excellent outcome. It is postulated that the SDH resulted from downward migration of intracranial hematoma.     

Spinal subarachnoid hematoma after lumbar puncture in a patient with leukemia: report of a case and review of the literature

Acute myeloradicular compression due to a spinal subarachnoid hematoma (SSAH) after lumbar puncture (LP) is an extremely rare complication. Several risk factors have been involved in the production of these hematomas, mainly the presence of hemostasis disorders in the patient. We report the case of a 20-year-old man with leukemia and thrombocytopenia (26,000 platelets/mm(3)) who, after undergoing a LP, developed paraparesis and became unable to stand. A magnetic resonance disclosed the presence of a ventral intradural hematoma from D12 to L4. An emergency decompressive laminectomy was performed and a hematoma located in the subarachnoid space was partially removed. On the fourth postoperative day, the patient was able to walk without assistance, but one month later, he died because of systemic complications of his disease. Only 26 cases of SSAH after LP have been found in the literature review we have performed. In most of them, the following common features have been observed: association with anticoagulant therapies, association with thrombocytopenia, delayed onset of compressive myeloradicular syndrome, need of surgical treatment, good functional outcome in half of patients, and short life expectancy for patients with previous serious illness. Risk for developing a SSAH after LP could be high in leukemia patients with a tendency to have severe thrombocytopenia (perhaps less than 25,000 platelets/mm(3)).     

Symptomatic spinal epidural CSF collection after lumbar puncture in a young adult: case report and review of literature

Lumbar puncture is a very common neurological diagnostic procedure which is associated with minimal risk. Epidural cerebrospinal fluid (CSF) collection can occur after puncture of the dura from extravasation of CSF from the thecal sac. On rare occasions, the epidural collection can be large enough to cause neurological dysfunction. The epidural fat has less fibrous stroma in children compared to adults, and it is postulated that this facilitates the dissection of CSF along epidural space. We report a rare case of a large symptomatic spinal epidural CSF collection shortly after lumbar puncture presenting with severe leg pain. The patient recovered fully within 48 h with bed rest and analgesia, and repeat imaging 1 month later showed good resolution of the epidural collection. Review of the literature revealed that epidural CSF collections resolve with conservative measures without the need for surgical intervention even in the setting of significant neurological symptomatology.     

Spontaneous spinal epidural hematoma: a case report and review of the literatures

Purpose: To emphasize the importance of early recognition and emergent surgery for spontaneous spinal epidural hematoma (SSEH). Case Report: A 61-year-old female presented with sudden onset of severe neck and back pain after finishing worshiping Buddha followed by quadriparesis, sensory deficits below C4 level and sphincter dysfunction. MR imaging demonstrated acute extensive epidural hematoma of cervico-thoracic spinal segments (C2-T7). Idiopathic SSEH was diagnosed and emergent decompressive laminectomy with hematoma evacuation was performed within 12 hours of symptoms onset. Good functional and neurological outcomes were obtained. Conclusion: SSEH is a rare but disabling or even fatal entity. Early diagnosis and prompt surgery improve the neurological and functional outcome but still remain a clinical challenge. Relevant physicians should pay attention to the typical symptoms of the rare entity and SSEH should be one of differential diagnoses.     

Hemophilia and child abuse as possible causes of epidural hematoma: case report

INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the "whiplash shaken-baby syndrome", which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this etiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.     

Extended spontaneous spinal epidural anterior hematoma over multiple spinal segments. A case report]

We reported a case of extended spontaneous spinal epidural hematoma over multiple spinal segment. A 68-year-old man presented with sudden onset of back pain. He rapidly developed tetraplegia within 15 minutes. On admission, he showed tetraplegia, sensory loss below C4 dermatome, right Horner's sign and bilateral Babinski's signs. These neurological signs gradually improved and disappeared completely within 5 hours. MR imaging showed extended hematoma in the anterior part of spinal epidural space. Spinal angiogram showed no vascular anomaly. The patient had nine years history of antiplatelet therapy, which would produce this episode of the spinal epidural hematoma. The hematoma located in the anterior part of the epidural space and extended over multiple spinal segments was characteristic features in this case. In the case which could have early neurological recovery, conservative therapy might be indicated.     

急性硬膜外血肿伴蛛网膜囊肿一例

患者 男,20岁,工人,因骑摩托车跌伤后头痛、恶心12 h入院.查体:神志清,精神差,瞳孔无异常,左额颞顶肿胀,头皮裂伤,皮下有波动感,可触及颅骨凹陷;左耳听力差,外耳道未见流血;颈部活动稍受限,上颈部压痛.头部CT示左额颞顶硬膜外血肿伴颅内积气,左额颞顶多发颅骨骨折:左额颞蛛网膜囊肿.     

Vertex epidural hematoma with bilateral abducent nerve palsy: case report and literature review

Epidural hematomas which are located at the vertex are rarely seen and form a small percentage of total epidural hematomas. Tearing in the superior sagittal sinus is the usual cause of an epidural hematoma located in the vertex. The clinical features of this entity are non-specific; hence, localization of the lesion is difficult. We report an adult who was hit by a motorcycle and was initially discharged from the hospital as a case of concussional head injury. He returned back with raised intracranial pressure symptoms, so a CT scan was done but was misinterpreted, and he reported one week later with bilateral abducent nerve palsy. Magnetic resonance imaging confirmed vertex EDH for which he was operated.These hematomas are seen rarely and can be interpreted as an artifact. Its recognition is important because it has an excellent prognosis. We concluded that all head injury patients should get high axial cuts on the CT scan, and any degree of suspicion should prompt a neurosurgeon to investigate further with coronal CT scan or MRI.