Postlumbar puncture spinal intradural hematoma: A case report and literature review

Spinal intradural hemorrhage/hematoma is an uncommon but clinically significant complication of lumbar puncture. We report a previously healthy man in his mid-30s who developed severe low-back pain with bilateral radiculopathy and dysesthesia later the same day followi lumbar puncture performed for headache and fever. He represented 5 days later; coagulation test results were normal. Contrast-enhanced lumbar magnetic resonance imaging demonstrated a ventral mass-like intrathecal lesion extending from L4 to S1 with minimal enhancement, compatible with an early subacute intradural hematoma. He improved with conservative management and close observation without neurologic deficits. To contextualize this case, we performed a targeted PubMed/MEDLINE search through November 2025 and a narrative review of postlumbar puncture spinal intradural hemorrhage/hematoma reports published over the past 10 years. Thirty publications describing 37 patients with spinal intradural hemorrhage/hematoma were identified: symptom onset occurred within 24 h in 54.0% and beyond 48 h in 13.5%; thoracic/thoracolumbar involvement slightly exceeded lumbar/lumbosacral involvement (54.1% vs. 45.9%); and the subarachnoid (45.9%) and subdural (37.8%) compartments predominated. Spinal intradural hemorrhage/hematoma may occur despite normal coagulation findings and can mimic an intradural mass on early magnetic resonance imaging; prompt spinal magnetic resonance imaging and early specialist input are warranted when severe or progressive postlumbar puncture symptoms develop.