Subdural Hematoma After Lumbar Puncture in Patients with Coagulation Disorders: A Case Report and Pathogenetic Implications

BACKGROUND To report the clinical events and intraoperative imaging features of a subdural hematoma after lumbar puncture in a patient with coagulation disorder following sinus thrombosis. The pathogenesis was discovered during the removal of a subdural hematoma by emergency neurospinal surgery. We also discuss how these factors could be avoided. CASE REPORT A 15-year-old girl received treatments in the Emergency Department of Neurology of Xuanwu Hospital, Capital Medical University, in May 2024. She was treated with anticoagulation for cerebral venous sinus thrombosis developed into an intraspinal hematoma after a lumbar puncture. She had cranial hypertension and was finally treated for the removal of an intraspinal hematoma. During the operation for removal of the intraspinal hematoma, the lumbar puncture needle penetrated the dorsal and ventral dura, presumably puncturing the anterior vertebral venous plexus. Due to the rapid release of a large amount of cerebrospinal fluid, negative pressure developed in the spinal canal, resulting in massive bleeding and intraspinal hematoma. She had neurological impairment before emergency surgery, but the neurological dysfunction improved after surgery, and no sequelae remained. CONCLUSIONS In patients with coagulopathy, if a lumbar puncture examination must be performed, it is necessary to pay attention to the puncture depth, while avoiding subdural blood inhalation due to the massive release of cerebrospinal fluid after penetrating the dorsal and ventral dura and damaging the anterior sacral venous plexus.