Acute Paraplegia due to Spinal Subarachnoid Hematoma after Lumbar Puncture

Case Report

Abstract

A 50-year-old male with advanced gastric cancer underwent artificial anal colostomy to improve ileus under lumbar anesthesia. After surgery the patient developed paraplegia. Myelography and computed tomography revealed an intradural hematoma at the thoracolumbar region. Emergency laminectomy showed that the subarachnoid hematoma was compressing the spinal cord at the levels from Th₁₀ to L₂.
Lumbar puncture, myelography, and lumbar anesthesia are performed very often because of their clinical importance and benefits, and complications of these procedures are infrequent and usually insignificant. However, on rare occasions serious complications do occur, among which intraspinal canal hematoma causing paraplegia is the most severe. According to the literature, epidural hematomas occur most often, followed by subdural hematomas, whereas subarachnoid hematoma after lumbar puncture is extremely rare. Among the proposed factors that lead to this complication are bleeding tendency, thrombocytopenia, anticoagulant drug therapy, multiple punctures, and pre-existing narrow spinal canal.