ABSTRACT
INTRODUCTION: Spinal cord hematoma is a serious and feared complication of lumbar puncture. We here describe two patients who developed a spinal cord hematoma following diagnostic lumbar punctures. CASE REPORTS: CASE 1: a 22-year-old male with a syndrome of cerebrospinal fluid hypotension, with normal coagulation parameters, underwent a traumatic, diagnostic lumbar puncture followed, a few hours later, by back pain irradiated to the legs. MRI showed the presence of a subdural hematoma from the lower dorsal region to the sacral region. A conservative approach, without surgery, was decided and he showed a complete recovery. CASE 2: a 69-year-old woman underwent a diagnostic lumbar puncture for the study of recent-onset headache with tinnitus and unstable gait. Puncture was traumatic and cerebrospinal fluid was normal. A few hours later, she complained of back pain and sciatica, and examination revealed a bilateral Lassegue sign. She required urinary catheterization. MRI showed an epidural hematoma from the T10 vertebra to the sacral area. Her outcome with a conservative approach was also excellent. CONCLUSIONS: Spinal cord hematomas can occur after a traumatic lumbar puncture in people without coagulation disorders or any other predisposing factor. Although surgery has been traditionally advocated in these cases, a conservative approach is an option when symptoms are mild and a close follow-up is possible.
Subject(s)
Hematoma, Subdural, Spinal/etiology , Spinal Cord Vascular Diseases/etiology , Spinal Cord , Spinal Puncture/adverse effects , Aged , Female , Hematoma, Subdural, Spinal/pathology , Humans , Male , Postoperative Complications , Recovery of Function , Spinal Cord/pathology , Spinal Cord/surgery , Spinal Cord Vascular Diseases/pathology , Young AdultABSTRACT
Introducción. El hematoma espinal es una grave complicación de la punción lumbar. Se muestran los casos de dos pacientes que presentaron hematomas espinales tras la práctica de punciones lumbares diagnósticas. Casos clínicos. Caso 1. Varón de 22 años, con hipotensión de líquido cefalorraquídeo y estudio de coagulación normal. Se le realizó una punción lumbar que fue traumática y en las siguientes horas desarrolló dolor lumbar con irradiación radicular. En la resonancia magnética se detectó la existencia de un hematoma subdural desde la región dorsal baja hasta la región sacra. El tratamiento fue conservador, sin cirugía, con una excelente evolución. Caso 2. Mujer de 69 años a quien se le realizó una punción lumbar diagnóstica para el estudio de una cefalea de reciente comienzo con acúfenos e inestabilidad. La punción lumbar fue traumática, y se obtuvo un líquido cefalorraquídeo normal. Horas después presentó dolor lumbar con irradiación radicular. En la exploración se apreció un signo de Lassegue positivo y precisó sondaje urinario. En la resonancia magnética se observó un hematoma epidural desde D10 hasta la región sacra. Su evolución, tratada de forma conservadora, también fue satisfactoria. Conclusiones. Las punciones lumbares traumáticas favorecen el desarrollo de hemorragias espinales en pacientes sin coagulopatías u otros factores de predisposición. Aunque en estos casos se ha recomendado un tratamiento quirúrgico, la actitud terapéutica puede ser conservadora cuando el cuadro clínico sea menor y se garantice un estrecho seguimiento (AU)
Introduction. Spinal cord hematoma is a serious and feared complication of lumbar puncture. We here describe two patients who developed a spinal cord hematoma following diagnostic lumbar punctures. Case reports. Case 1: a 22-year-old male with a syndrome of cerebrospinal fluid hypotension, with normal coagulation parameters, underwent a traumatic, diagnostic lumbar puncture followed, a few hours later, by back pain irradiated to the legs. MRI showed the presence of a subdural hematoma from the lower dorsal region to the sacral region. A conservative approach, without surgery, was decided and he showed a complete recovery. Case 2: a 69-year-old woman underwent a diagnostic lumbar puncture for the study of recent-onset headache with tinnitus and unstable gait. Puncture was traumatic and cerebrospinal fluid was normal. A few hours later, she complained of back pain and sciatica, and examination revealed a bilateral Lassegue sign. She required urinary catheterization. MRI showed an epidural hematoma from the T10 vertebra to the sacral area. Her outcome with a conservative approach was also excellent. Conclusions. Spinal cord hematomas can occur after a traumatic lumbar puncture in people without coagulation disorders or any other predisposing factor. Although surgery has been traditionally advocated in these cases, a conservative approach is an option when symptoms are mild and a close follow-up is possible (AU)
Subject(s)
Humans , Spinal Puncture/adverse effects , Hemorrhage/etiology , Spinal Injuries/etiology , Iatrogenic Disease , Lumbosacral Region/injuries , Risk Factors , Informed Consent , Hemorrhagic Disorders/complications , Magnetic Resonance SpectroscopyABSTRACT
OBJECTIVE: To evaluate the cerebral metabolic changes in paediatric patients using proton magnetic resonance spectroscopy. PATIENTS AND METHODS: We studied 31 patients diagnosed as having autism (autistic group) using cerebral magnetic resonance and hydrogen spectroscopy, together with 15 patients without autism (control group). The groups were sub divided according to age: 0-3 years, 4-7 years and 8-13 years. The morphology of the brain was studied using magnetic resonance and hydrogen spectroscopy of the thalamus. In each case we evaluated the presence of morphological changes in the brain and the concentrations of the cerebral metabolites N acetyl aspartate(NAA), choline (Cho) and creatinine (Cr) by measuring the coefficients NAA/Cr, NAA/Cho and Cho/Cr coefficients, and also any anomalous concentrations of other metabolites. RESULTS: No morphological changes were seen in the brains studied. There was no significant increase in minor metabolites in any of the groups studied. Significant differences in the NAA/Cho and NAA/Cr coefficients between the control and autistic groups were only seen in the oldest subgroup (8-13 years), but in the other groups the differences were not significant. The results in the sub group of older autistic children are similar to those of the younger subgroups in both autistic and control groups. CONCLUSION: The spectroscopic findings showed similar recordings in the control group and in the autistic group up to the age of 7 years with reduced thalamic NAA in autistic patients older than this. This suggests interruption and regression in the process of neuronal maturity, in which the thalamus also plays a part.
