Symptomatic spinal epidural CSF collection after lumbar puncture in a young adult: case report and review of literature

Lumbar puncture is a very common neurological diagnostic procedure which is associated with minimal risk. Epidural cerebrospinal fluid (CSF) collection can occur after puncture of the dura from extravasation of CSF from the thecal sac. On rare occasions, the epidural collection can be large enough to cause neurological dysfunction. The epidural fat has less fibrous stroma in children compared to adults, and it is postulated that this facilitates the dissection of CSF along epidural space. We report a rare case of a large symptomatic spinal epidural CSF collection shortly after lumbar puncture presenting with severe leg pain. The patient recovered fully within 48 h with bed rest and analgesia, and repeat imaging 1 month later showed good resolution of the epidural collection. Review of the literature revealed that epidural CSF collections resolve with conservative measures without the need for surgical intervention even in the setting of significant neurological symptomatology.