Delayed Subdural Hematoma After Lumbar Puncture and a Symptom-Free Interval of Several Days

Figure

a) Cranial magnetic resonance imaging (FLAIR sequence) prior to lumbar puncture showing an aspect of normal pressure hydrocephalus; b) cranial computed tomography with left-sided subdural hematoma and hemorrhage, left-sided cerebral edema, and 12-mm midline shift to the right 13 days following lumbar puncture

A 74-year-old female patient with depression and an eating disorder (BMI 13.2 kg/m²) showed clinical (abnormal gait, incontinence, and forgetfulness) and, on the basis of magnetic resonance imaging (Figure a), morphological signs of normal pressure hydrocephalus, while laboratory values were unremarkable. A spinal tap test (21 mL) was performed, resulting in improved gait. At 5 days following lumbar puncture, the patient complained of mild headache, the nature of which she was familiar with. At 13 days following the procedure, the patient was found in bed in a state of somnolence. Cranial computed tomography revealed a fresh, left-sided frontotemporoparietal subdural hematoma (Figure b). Emergency craniotomy resulted in an almost complete remission of neurological symptoms. The patient had recently started taking escitalopram, which could have increased her risk of bleeding. Other plausible causes of the bleeding (for example, falls, even within the previous months, a coagulation disorder) could not be identified, making the lumbar puncture appear the likeliest cause. The present case highlights the fact that, even in the case of a symptom-free interval of several days prior to the onset of symptoms following lumbar puncture, subdural hematoma needs to be taken into consideration

Dario Jalilzadeh Masah, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Charité Universitätsmedizin Berlin
Dr. med. Dorett Hoffmann, Institut für Radiologie, St. Hedwig-Krankenhaus, Berlin
PD Dr. med. Eva Janina Brandl, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Charité Universitätsmedizin Berlin;

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Jalilzadeh Masah D, Hoffmann D, Brandl EJ: Delayed subdural hematoma after lumbar puncture and a symptom-free interval of several days. Dtsch Arztebl Int 2022; 119: 200. DOI: 10.3238/arztebl.m2022.0022