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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0634

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Symptomatic Spinal Epidural Collections after Lumbar Puncture in Children

B.L. Koch^a, E.A. Moosbrugger^a and J.C. Egelhoff^a

^a From the Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

View larger version (60K): [in this window] [in a new window]   Fig 1. Sagittal MR images of patient 8 showing thoracolumbar EDC 1 day post-LP. A, Noncontrast sagittal T1-weighted image (TR/TE, 638.3/14) shows low-signal-intensity EDC extending from at least T11-S1. The epidural fat pads are heterogeneous (arrows) secondary to infiltrating fluid. B, Sagittal T2-weighted image (TR/TE, 3260.9/125) shows high-signal-intensity EDC elevating and infiltrating "floating" epidural fat pads (long arrows) and deviating the dura anteriorly (short arrows).

View larger version (58K): [in this window] [in a new window]   Fig 2. Sagittal postcontrast MR images of patient 19 showing very extensive EDC 1 day post-LP. A, Contrast-enhanced T1-weighted image (TR/TE, 500/14) shows high-signal-intensity EDC, which extended from C7-L4 (cervical images not included). B, Contrast-enhanced T2-weighted image (TR/TE, 4000/115) shows very-high-signal-intensity EDC, hyperintense to CSF, with compression of the thecal sac and anterior deviation of the dura (short arrows). Heterogeneous floating fat pads (long arrows) are more obvious on the T2-weighted image.

View larger version (42K): [in this window] [in a new window]   Fig 3. MR images of patient 2 showing extensive EDC 1 day post-LP. A, Noncontrast T1-weighted image (TR/TE, 500/9) of the spine shows a low-signal-intensity EDC extending from the upper thoracic level of the spine to the sacral level. Elevated epidural fat pads (arrows) can be seen and appear heterogeneous due to fluid infiltration. B, Noncontrast T2-weighted image (TR/TE, 4000/126) of the spine shows high-signal-intensity EDC. Epidural fat pads (long arrows) are elevated, and the dura is deviated anteriorly (short arrows). C, Axial T2-weighted image (TR/TE, 4000/126) at the level of the conus shows heterogeneous signal intensity in the dorsal epidural space secondary to fluid elevating and infiltrating the epidural fat pads. There is resultant deviation of the dura anteriorly.

View larger version (56K): [in this window] [in a new window]   Fig 4. Sagittal MR images of patient 5 showing initial EDC 4 days post-LP and resolution of EDC 13 days later. A, Noncontrast sagittal T1-weighted image (TR/TE, 500/12) shows hypointense EDC extending from T12-S2. Epidural fat pads (arrows) are shown to be elevated and infiltrated with low-intensity fluid. B, Noncontrast sagittal T2-weighted image (TR/TE, 5000/135) obtained at the same time as A shows hyperintense fluid deviating the dura anteriorly (short arrows) effacing the CSF and elevating the fat pads (long arrows), which are infiltrated with fluid. C and D, Sagittal T1-weighted (C) (TR/TE, 500/12) and sagittal T2-weighted (D) (TR/TE, 5000/133) images obtained 17 days post-LP show resolution of EDC. Epidural fat pads (arrows) are normal in position and homogeneous. The dura is no longer deviated, and the intrathecal CSF is not effaced.