Medullary infarction leading to "locked-in" syndrome following lumbar puncture in a patient with basilar invagination

Introduction Lumbar puncture is a common procedure that can be safely performed in the majority of patients. Certain populations may have increased risk for complications following lumbar puncture, but the significance of basilar invagination is often underappreciated. Report of a case We report the case of a patient with basilar invagination who received multiple lumbar punctures in the workup of acute meningitis. A preprocedural CT was obtained. Following lumbar puncture, the patient developed "locked-in" syndrome. Postprocedural MRI obtained several days later demonstrated severe compression and infarction of the medulla and inferior cerebellum by the odontoid process and ectopic cerebellar tonsils. Discussion Basilar invagination is a risk factor for devastating neurological complications following lumbar puncture. Awareness of this complication and prompt recognition of its occurrence may prevent future morbidity of lumbar puncture in patients with basilar invagination.