Abstract Details

Title Post Lumbar Puncture Spinal Epidural Venous Engorgement–A Potential Imaging Trap

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 183

Objective The classical symptom of intracranial hypotension is acute orthostatic headache. This is most commonly encountered after iatrogenic or spontaneous dural tears, but may also be seen following lumbar puncture. The classically recognized radiological signs of intracranial hypotension are the ones described in cranial imaging, and include signs related to cerebral venous congestion and brain descent. Less frequently encountered clinical symptoms include nausea, vomiting, diplopia, photophobia, neck pain, and blurred vision.Similarly, less commonly, the imaging signs may be localized to spine, including extra-arachnoid CSF collection, dilated dural veins, and dural enhancement.

Background We present a case of a 42 year-old woman undergoing evaluation for progressive distal weakness and numbness in all four extremities. She underwent lumbar puncture as a part of the workup. Post-procedure, she developed acute neck pain, for which she underwent cervical spine MRI. The MRI revealed an enhancing epidural process extending ventrally along the spinal canal from clivus to upper thoracic spine, initially raising suspicion for meningitis or epidural abscess. Since she did not have symptoms suggestive of either, she was managed conservatively. A follow-up MRI performed three days later showed prominent improvement in the imaging findings. Based on the imaging findings and their course, it was determined that the changes were likely secondary to epidural venous engorgement.

Design/Methods NA

Results NA

Conclusions Spinal epidural venous engorgement can occur secondary to intracranial hypotension (mainly post lumbar puncture), and can present clinically with neck pain or even symptoms of radiculopathy.Since the findings can mimic more serious conditions, it is extremely important to consider this condition in the differential diagnosis of an enhancing epidural collection in the cervical spine, particularly when intracranial hypotension is suspected.

Authors/Disclosures
Khaled Gharaibeh, MD (ProMedica Neurosciences Center) PRESENTER	Dr. Gharaibeh has nothing to disclose.
Hira Pervez, MD, MBBS (University of Toledo)	Dr. Pervez has nothing to disclose.
Ajaz Sheikh, MD (ProMedica Neurosciences Center)	Dr. Sheikh has nothing to disclose.

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