Spinal subdural haematoma following traumatic lumbar puncture in a patient with normal coagulation profile

Spinal subdural haematoma following lumbar puncture is a rare cause of spinal cord compression with very few cases reported in the literature. It is usually associated with some predisposing factors like haemorrhagic diathesis, anticoagulant therapy, vascular malformation, tumour or trauma. The authors report a case of spinal subdural haematoma in a 30-year-old male following a traumatic lumbar puncture with no obvious coagulation disorder. The patient had a poor outcome with minimal improvement in paraparesis at last follow-up, even after timely decompression. Although coagulation abnormalities are commonly found in most of these cases, our case illustrates the fact that spinal subdural haematoma can occur even in the presence of normal coagulation profile and a high index of suspicion with early diagnosis and intervention is warranted to prevent irreversible neurological deterioration, especially following a traumatic lumbar puncture

Acute epidural haematoma following ventriculoperitoneal shunt in an adult

The authors report a 50-year-old patient of pituitary macroadenoma with hydrocephalus, who developed a large left parieto-occipital epidural haematoma following placement of a ventriculoperitoneal shunt. This is the first case report describing this complication in an adult patient, and it is hypothesised that coagulation of the dura along with rapid lowering of intracranial pressure, may lead to its stripping from the bone with attendant tear in the emissary vein [s] resulting in the possibility of epidural haematoma formation in adults. Judicious dural coagulation should therefore avoid this uncommon and potentially life-threatening condition

Surgery in adult spinal dysraphism: a series of 51 patients

To study the various clinical presentation of spinal dysraphism in adults and analyse the risks and benefits of surgical treatment for spinal dysraphism in adults. Patients of spinal dysraphism who were operated after 16 years of age were included in this study and the clinical-radiological details, operative finding and histopathological findings of these patients were analysed. Age of the patients ranged from 16 - 58 years, with the mean age at surgery being 24.5 years. Lipomatous malformation was the commonest associated anomaly [53%] followed by split cord malformations [23.6%]. Sensory [62.7%], motor [60%] and bladder disturbances [49%] were the most common presentations. Detethering led to resolution of pain in 68%, healing of trophic ulcers in 100% and improvement in motor and sensory symptoms in 29% and 37.5% of the patients respectively. The results for sphincter dysfunction were particularly disappointing and none of these patients had improved during the follow-up period. There was no deaths or major postoperative complication in this study. This study clearly shows that a substantial number of patients benefit by surgery with the surgical outcome being excellent for healing of trophic ulcers and relieving pain. However, as none of the patients with established sphincter disturbances improved following surgery, prophylactic surgery early in childhood may be required in this group of patients to prevent the development of autonomic disturbances