Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 41; no. 9; pp. 791 - 795
• Main Authors: OPENSHAW, H, RESSLER, J. A, SNYDER, D. S
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.05.2008
• Subjects: Acute myeloid leukemia; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cerebrospinal fluid; Diagnosis; Diagnostic tests; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hematologic Neoplasms - therapy; Hematoma; Hematoma, Subdural, Spinal; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Injections, Spinal - adverse effects; Intracranial pressure; Leukemia; Lymphatic leukemia; Male; Medical sciences; Middle Aged; Myelodysplastic syndrome; Nervous system (semeiology, syndromes); Neurology; Patients; Puncture; Retrospective Studies; Risk analysis; Risk Factors; Spinal Puncture - adverse effects; Spine; Stem cell transplantation; Subdural Effusion; Subdural hematoma; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Transplantation, Homologous; Transplants & implants; United States; Human; Headache; Subdural; Nervous system diseases; Hematology; Hematopoietic cell; Intracranial hypotension; Cardiovascular disease; Vascular disease; subdural hematoma; Pain; subdural hygroma; Hygroma; Puncture; Neurological disorder; post-lumbar puncture headache
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705971

We reviewed records of hematopoietic cell transplantation (HCT) patients seen over the past 10 years who had head scan documentation of subdural fluid collections. A total of 17 patients were identified: 13 with allogeneic and 4 with autologous HCT (0.71% of allogeneic and 0.13% of autologous HCT patients seen in this time interval). Although less than 20% of HCT patients have lumbar puncture, 8 of the 17 subdural patients had lumbar puncture. The lumbar puncture was done 5-112 days (median 46 days) before subdural detection. Acute lymphocytic leukemia was the diagnosis in five of these eight; whereas, either acute myelogenous leukemia or myelodysplasia was the diagnosis in seven of the nine patients without lumbar puncture. In the patient group with lumbar puncture, subdurals were diagnosed earlier after HCT (median 25 days versus 5 months in the patient group without lumbar puncture) and were more often hygromas (37.5 versus 0%). These results support the suggestion of lumbar puncture or intrathecal therapy as a risk factor for subdurals. The presumptive mechanism involves lumbar cerebrospinal leak, low intracranial pressure, downward displacement of the brain, cerebrospinal fluid accumulation into the inner dural layers of the cerebral convexities (hygromas) and bleeding into these fluid collections (hematomas).