J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 7, Number 10, October 2016, pages 461-466

Central Nervous System Hemorrhage Following Lumbar Puncture for Intrathecal Chemotherapy in a Pediatric Oncology Patient

Figure 1. Magnetic resonance imaging of the brain showing intraventricular T2 hypointense signal compatible with intraventricular hemorrhage. Dependent layering is seen within the occipital horns of the lateral ventricles.

Figure 2. Magnetic resonance imaging (T2-weighted) showing blood filling the caudal aspects of the thecal sac (green arrow). Significant bladder distention is also noted anteriorly.

**Table 1.** Previous Reports of Hemorrhagic Complications After Lumbar Puncture in Children
Author	Case	Hemorrhagic complication	Procedure	Coagulation disorder	Neurologic deficit, therapies, and outcome
ALL: acute lymphoblastic lymphoma; LP: lumbar puncture; MRI: magnetic resonance imaging; IT: intrathecal.
Hatzipantelis et al [7]	5-year-old boy with ALL	Epidural hematoma	LP	Thrombocytopenia	Headache and lower back pain with paraparesis, decreased sensation of both legs, and urinary retention after LP. Sensation of lower extremities was recovered quickly, whereas motor function of legs improved gradually. Urinary retention followed a slower course of recovery.
Adler et al [9]	5-year-old boy	Epidural hematoma	LP for fever evaluation	None	Pain in the legs and back. MRI revealed epidural blood extending from L4-5 up to L2 with compression of the thecal sac. There was no progression of his neurologic symptoms and no surgical intervention was deemed necessary.
Boran et al [13]	6-year-old boy with non-Hodgkin lymphoma	Fronto-parietal hematoma	LP for IT chemotherapy	None	Right hemiparesis and focal seizures. Neurosurgery team recommended surgical evacuation of the hematoma, but the parents refused. The intracerebral hematoma resolved spontaneously over 6 weeks and the patient’s symptoms improved.
Tubbs et al [14]	Preterm infant	Conus medullaris hematoma	LP	None	Spontaneous movement of the lower extremities decreased after LP. Residual neurologic deficit with lower extremity paresis and incontinence of bowel and bladder.
Wirtz et al [15]	12-year-old boy	Spinal subdural hematoma	LP	Thrombocytopenia	Lower back pain, leg weakness, and urinary retention developed after LP. Surgical laminectomy was performed from T11 to L2 with partial evacuation of the hematoma. After surgery, his neurologic condition gradually improved. He was able to walk without support and urinary retention had resolved.

Table 1. Previous Reports of Hemorrhagic Complications After Lumbar Puncture in Children

Author

Case

Hemorrhagic complication

Procedure

Coagulation disorder

Neurologic deficit, therapies, and outcome

ALL: acute lymphoblastic lymphoma; LP: lumbar puncture; MRI: magnetic resonance imaging; IT: intrathecal.

Hatzipantelis et al [7]

5-year-old boy with ALL

Epidural hematoma

Thrombocytopenia

Headache and lower back pain with paraparesis, decreased sensation of both legs, and urinary retention after LP. Sensation of lower extremities was recovered quickly, whereas motor function of legs improved gradually. Urinary retention followed a slower course of recovery.

Adler et al [9]

5-year-old boy

Epidural hematoma

LP for fever evaluation

None

Pain in the legs and back. MRI revealed epidural blood extending from L4-5 up to L2 with compression of the thecal sac. There was no progression of his neurologic symptoms and no surgical intervention was deemed necessary.

Boran et al [13]

6-year-old boy with non-Hodgkin lymphoma

Fronto-parietal hematoma

LP for IT chemotherapy

None

Right hemiparesis and focal seizures. Neurosurgery team recommended surgical evacuation of the hematoma, but the parents refused. The intracerebral hematoma resolved spontaneously over 6 weeks and the patient’s symptoms improved.

Tubbs et al [14]

Preterm infant

Conus medullaris hematoma

None

Spontaneous movement of the lower extremities decreased after LP. Residual neurologic deficit with lower extremity paresis and incontinence of bowel and bladder.

Wirtz et al [15]

12-year-old boy

Spinal subdural hematoma

Thrombocytopenia

Lower back pain, leg weakness, and urinary retention developed after LP. Surgical laminectomy was performed from T11 to L2 with partial evacuation of the hematoma. After surgery, his neurologic condition gradually improved. He was able to walk without support and urinary retention had resolved.