AMONG THE MAJOR HAZARDS in the performance of a lumbar puncture is an increase in the intracranial pressure. Such increases in pressure encourage downward displacement of the cerebellar tonsils and their herniation into the foramen magnum. Consequent compression of the medulla against the bony rim of the foramen magnum produces bulbar symptoms and eventual respiratory or cardiac arrest.1 This complication can be exaggerated by removing even small amounts of cerebrospinal fluid (CSF) during lumbar puncture.
This case report illustrates the vigor with which such downward displacements may occur and reemphasizes the need for extreme caution in the performance of lumbar puncture whenever an increased intracranial pressure is present. We have been unable to find actual disruption of cerebellar substance reported as a complication of lumbar puncture.
Report of a Case
A 2-yr-old male was admitted to the emergency room of Mercy Hospital on Sept 7, 1961, at 12:40 pm,