Iatrogenic spinal subdural hematoma in undiagnosed thrombocytopenia: A rare case of delayed diagnosis mimicking neoplasm

Spinal subdural hematomas following lumbar puncture are rare but serious complications, typically associated with coagulopathies. We report a case of a 27-year-old male who developed progressive lower limb weakness and urinary incontinence after undergoing a diagnostic lumbar puncture at an outside facility. MRI spine initially suggested an intradural neoplasm due to clumped nerve roots and abnormal signal, delaying diagnosis. Further evaluation revealed previously undiagnosed thrombocytopenia (platelet count <30,000). The patient was managed conservatively following platelet transfusion with eventual neurological improvement. This case highlights the critical need for preprocedural coagulation screening and the diagnostic challenges posed by atypical imaging presentations of spinal hematoma.