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    What causes myelitis symptoms after lumbar puncture procedure?

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Posted on Mon, 30 Nov 2015 in Brain and Spine
Question: I had lumbar puncture. Felt severe pain when pushed needle near end procedure. I have stenosis mild n scoliosis as well as previous LP shunt removed. Overnight I could not move left toes then right n moved up to include ankles. XANTHOCHROMIA small amt in CSF protein .80 mri 4 days later didn't show bleeding. 2 years later still no ability to move any muscles in either leg below knee joints. What happened? CSF pressure was 25 when VP shunt set at 7
doctor
Answered by Dr. Neeraj Kumar 1 hour later
Brief Answer:
provide more details as asked

Detailed Answer:
Hello XXXX,
As communicated in previous question you may provide more details.
I have gone through your question and understand your concerns.
The possibility of Lumbar puncture related injury to cord is very uncommon as the level of lumbar puncture is below the cord level at roots level.
Other possibility may be traumatic blood related arachnoiditis or infection during procedure. These possibilities are also not in your case.
Is there any history of drug administration during procedure into spinal space as it may some time lead to injury.
You may be having myelitis after the procedure a coincidence.
IS your limbs flaccid or spastic?
A rare possibility may be injury to bilateral motor cortex in brain due to shunt ?
Have you consulted a neurologist and what are the examination findings?
You can upload his prescription for availability of such details.
Do get back with these details.regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Neeraj Kumar 51 minutes later
Hi
Multiple bottles of lidacane? Numbing agent put in because of the pain were put in
My calve muscles r tight sometimes but think from trying to walk in braces
Mri done 4 days after paralysis started was normal except for some stenosis
I had been admitted when I was vomiting profusely n bad headache
6 dAys after symptoms ran b12 n it was <137
Diagnosed 6 months later as having subacute degeneration of spine but no malabsorption issue, normal b12 tests w no treatment on day of diagnosis
Mri did not show any signs of subacute degeneration of spine. Given b12 shots for one week n b12 went normal but symptoms did not improve
Xanthochromia was found.
I d have angioneurotic edema in past issues w swelling after dental work caused hematoma
No medications were given after paralysis began
22 months later no recovery of muscles.
No demyelination of nerves found
No tests were run for over 100 hours.
No anti inflammatory es given
Had over sensitive reflexes in knees
Got a macular rash after LP


doctor
Answered by Dr. Neeraj Kumar 34 minutes later
Brief Answer:
Get investigated and evaluated by a neurologist and repeat investigations

Detailed Answer:
Hello ,
With above details your vitamin B12 levels were low at that time.
Lidocaine is also harmful for nerve roots and has been reported to cause transient neurological deficits and root irritation or caudal equina like presentation.
In your case there is possibility of baseline damage due to vitamin b 12 deficiency and additionally harmful effect of lidocaine .
You should consult neurologist for evaluation and examination and repeat vitamin B12 and homocysteine levels as initial injections normalises the levels.
For treatment at present time physiotherapy and vitamin B12 supplementation can be advised and any other intervention if found abnormal.
Repeat spine imaging can also be done.
You can upload prescription of initial records and reports if available.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Neeraj Kumar 17 hours later
Hi. The b12 level was initially checked initially 6 days after lumbar puncture paralysis. There is no malabsorption issue of b12 n not vegetarian

Shots were given but no improvement in Emg

B12 levels 6 months later normal w out any further treatment

B12 levels year later normal w out any treatment

My orthopedic surgeon told me for damage as severe as mine to occur 6 hrs after lumbar puncture it is most likely related to that

There was no signs on mri of spine of b12 damage to spinal cord

When I was in hospital after LP and could not move my feet the neurosurgical resident did not order any testing n thought I was faking.

No testing or treatment of any occurred for almost a week after paralysis occurred

I have scoliosis n stenosis and a difficult lumbar puncture n was not done under fluroscopy

Thank you for your kindness


doctor
Answered by Dr. Neeraj Kumar 12 hours later
Brief Answer:
Get investigated and take treatment as advised

Detailed Answer:
Hello dear,
Your clinical condition of paraparesis post lumbar puncture may be a complication of procedure or due to drugs administration lidocaine but this complication is very rare.
The weakness post LP is transient. It is lower motor neuron type, flaccid paralysis.
My advice for vitamin B12 and homocysteine is only to get you supplementation if found deficient.
Because only treatment at this scenario is physiotherapy and supplementation of vitamin if found lower.
Hope you recover early.
Wishing you good health.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Neeraj Kumar

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