UMEM Educational Pearls

Category: Pediatrics

Title: Epidural hematoma formation after pediatric lumbar puncture

Keywords: Infant fever, lumbar puncture, risks, ultrasound (PubMed Search)

Posted: 4/20/2018 by Jenny Guyther, MD (Updated: 3/5/2024)
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Unsuccessful lumbar punctures (LP) may lead to epidural hematoma (EH) formation at the site of needle insertion which may affect subsequent attempts and lead to no success or a grossly bloody sample.  There is no standard definition of a traumatic LP based on CSF red blood cell counts.  Gross blood may also be obtained by interrupting the vascular structures outside the spinal canal which would not result in EH formation.

This was a prospective study of children younger than 6 months who had an LP at a single children’s hospital.  Post LP ultrasounds were completed by the investigating team and interpreted by a pediatric radiologist. 74  patients were included in the study.  31% of the patients had evidence of a post LP EH.  17% fully effaced the thecal sac which would likely preclude future success at that anatomic site.  25% of patients where the clinician did not feel there was a traumatic attempt had evidence of an EH.The study was not powered to determine the risk factors for EH formation.  The study also did not look at any other consequences to EH.

Key points: Point of care ultrasound to evaluate EH and bleeding at the failed LP site my provide useful information for a location of subsequent attempts.  Also US to evaluate for bleeding in the spinal canal may help with interpretation of the CSF when a large number of red blood cells are present.  

References

Kusulas MP, Eutsler EP, DePiero AD.  Bedside Ultrasound for the Evaluation of Epidural Hematoma After Infant Lumbar Puncture.  Pediatric Emergency Care.  Epub ahead of print.  Feb 2018.