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Post–Lumbar Puncture Headache and Backache in Pediatrics: A Case Series and Demonstration of Magnetic Resonance Imaging Findings

Shireen Atabaki, MD; Daniel Ochsenschlager, MD; Gilbert Vezina, MD
Arch Pediatr Adolesc Med. 1999;153(7):770-773. doi:10.1001/archpedi.153.7.770.
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Lumbar puncture (LP) is one of the most frequently performed procedures in the pediatric emergency department (ED). Although post-LP complications have been described extensively in the adult medical literature, the exact incidence of such complications in pediatrics is unknown but is believed to be rare. In addition, there is little information pertaining to these complications in children.1

One of the first post-LP complications was reported in 1898 when August Bier, a founding father of modern anesthesia, developed a headache after undergoing spinal anesthesia.2 He postulated that this complication was due to cerebral spinal fluid (CSF) leakage at the puncture site. Other authors have suggested that post-LP headaches and backaches may be caused by epidural fluid collections.3

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Figure 1.

Sagittal (left) and axial (right) T1-weighted images (patient 1). The cauda equina roots (arrows) are compressed within the thecal sac by an abnormal fluid collection, which surrounds the sac.

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Figure 2.

Axial fat-suppressed T2-weighted image at the L2 level (patient 2). Abnormal bright fluid surrounds the thecal sac (arrows).

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Figure 3.

Left, Sagittal T1-weighted image through the midline of the cranium. The optic chiasm is displaced inferiorly (double arrows), the brainstem foreshortened, the fourth ventricle is small (short arrow), and the intracranial dura is thickened (long arrows). Right, Axial T1-weighted images at the upper lumbar level reveal compression of the cauda equina within the thecal sac (arrows) by abnormal epidural fluid.

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