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

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. 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. 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. Complications of LPs are rare but may be life-threatening. Post-LP headache and backache are the most common complications and probably occur with greater frequency than reported because infants and many young children cannot verbalize their complaints. The following is a retrospective review of a series of children who presented to our ED with post-LP headache backache extremity pain and numbness. We describe their clinical presentations magnetic resonance imaging (MRI) studies and treatments and discuss possible mechanisms of these complications. (excerpt)