title: Cerebrospinal fluid dissecting into spinal epidural space after lumbar puncture causing cauda equina syndrome: review of literature and illustrative case.
abstract: OBJECTIVE
  We report a case of epidural cerebrospinal fluid (CSF) leak after lumbar puncture caused by CSF dissecting into the spinal epidural space. The incidence of this phenomenon may be higher than suspected, although most cases may remain asymptomatic.
  
  
  METHODS
  A 4-year-old girl with new-onset seizure underwent a diagnostic lumbar puncture, the results of which were normal; 3 h later, she began experiencing severe low-pressure headaches and lower back pain, bilateral lower extremity weakness, numbness, and pain, and urinary retention when upright. Spinal MRI demonstrated extensive epidural CSF collection posterior to the thecal sac extending from the cervicothoracic junction to the sacrum. After 48 h in the supine position and gradual mobilization, the patient had complete resolution of symptoms and no neurological sequelae.
  
  
  CONCLUSIONS
  Patients usually recover without any neurological deficits after conservative treatment. Prone or lateral decubitus positioning immediately after lumbar puncture may decrease the incidence of this phenomenon.
authors.affiliation: Division of Pediatric Neurosurgery, Primary Children's Medical Center, 100 North Medical Drive, Salt Lake, UT 84113, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Amini
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Brockmeyer
mesh_terms: D002555:Cerebrospinal Fluid / Q000378:metabolism*; D002675:Child, Preschool; D004824:Epidural Space / Q000378:metabolism*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011128:Polyradiculopathy / Q000209:etiology* / Q000378:metabolism* / Q000473:pathology; D013129:Spinal Puncture / Q000009:adverse effects*