Extensive subarachnoid and epidural hematoma after lumbar puncture

Emergency physicians across the country perform uncomplicated lumbar punctures on shift every day. If a complication does arise, it is often relatively benign, such as back pain at the site of needle insertion or headache and resolveswithminimal intervention with no long-term morbidity. However, given the frequency with which the procedure is performed, many physicians will eventually confront rare but serious complications. This case report details the history of a 64 year old woman who presented to the emergency department with back pain shortly after a hospitalization for altered mental status during which she underwent a diagnostic lumbar puncture. She was found to have a significant thoracic and lumbar subarachnoid and epidural hematoma. We discuss the outcome of the case as well as the diagnosis and management of this complication. We also review the literature on performing a lumbar puncture on a patient with coagulopathy.