Lumbar puncture (LP) is a common diagnostic procedure in clinical neurology. Iatrogenic spinal haema- tomas can be a complication of LPs and range from mild and self-resolving to very severe or even fatal. We describe a case report and review current literature on post-LPs spinal haematomas.

A 28-year-old Lady with a background of post-meningitic hydrocephalous treated with a ventriculoperi- toneal shunt had recurrent headaches and blurred vision. For this reason, she had numerous attendances to the emergency department where she had a total of 15 LPs. At the time, there was no coagulopathy, but patient was taking sertraline regularly. She presented again, five days after a traumatic tap, with bilateral sciatica, saddle paraesthesia and urinary incontinence. She was diagnosed with iatrogenic epidural lumbosacral haematoma causing incomplete cauda equina. Following conservative treatment, the haematoma partially resorbed, but the patient was left with residual saddle paraesthesia and urinary incontinence.

Between 1974 to 2022, 41 case reports on LP-related spinal haematomas have been published. Coagu- lopathy is the only risk factor identified, although correlations with outcome are confounded by comorbidi- ties. Treating ICP disorder headaches with LP is not recommended due to poor evidence of prolonged efficacy and this case highlights a significant associated risk.