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Cerebrospinal Fluid Leakage After Lumbar Puncture in Neonates: Incidence and Sonographic Appearance

¹ All authors: Department of Pediatrics, University Hospital Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.

View larger version (109K): [in a new window]   Fig. 1A. —14-day-old premature female infant (gestational age, 35 weeks) with normal spinal canal. Longitudinal sonogram of thoracic spine shows spinal cord (arrowheads) surrounded by anechoic cerebrospinal fluid (asterisks). Dura mater (arrows lies close to wall of spinal canal. V = vertebral bodies.

View larger version (96K): [in a new window]   Fig. 1B. —14-day-old premature female infant (gestational age, 35 weeks) with normal spinal canal. Longitudinal sonogram of lumbar spine shows conus medullaris (arrowheads) and cauda equina (C) surrounded by anechoic cerebrospinal fluid (asterisks). Note dura mater (arrows). V = vertebral bodies.

View larger version (130K): [in a new window]   Fig. 1C. —14-day-old premature female infant (gestational age, 35 weeks) with normal spinal canal. Axial sonogram of lumbar spine shows conus medullaris (arrowheads). + = epidural veins.

View larger version (100K): [in a new window]   Fig. 2A. —27-day-old male neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Longitudinal sonograms of lumbar (A) and (B) spine show epidural cerebrospinal fluid collection (asterisks) with markedly compressed subarachnoid space and bundled cauda equina (C). Note floating fat (F) and shifted dura mater (arrows).

View larger version (105K): [in a new window]   Fig. 2B. —27-day-old male neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Longitudinal sonograms of lumbar (A) and sacral (B) spine show epidural cerebrospinal fluid collection (asterisks) with markedly compressed subarachnoid space and bundled cauda equina (C). Note floating fat (F) and shifted dura mater (arrows).

View larger version (142K): [in a new window]   Fig. 2C. —27-day-old male neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Floating fat (F) shows characteristic triangular structure on axial sonogram of sacral spine. Bundled cauda equina (C) is surrounded by epidural cerebrospinal fluid collection (asterisk). Note dura mater (arrows).

View larger version (136K): [in a new window]   Fig. 3A. —1-day-old male neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Longitudinal thoracic sonogram shows fluid accumulation asterisks (extending to high-thoracic level. Floating fat (F) shows characteristic wavy appearance.

View larger version (107K): [in a new window]   Fig. 4A. —3-day-old female neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Longitudinal sonogram of thoracic spine shows epidural cerebrospinal fluid collection (asterisks) tapering cranially at high-thoracic level. Note spinal cord (arrowheads) and shifted dura mater (arrows).

View larger version (123K): [in a new window]   Fig. 4B. —3-day-old female neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Longitudinal sonogram at same level as A obtained 3 days after lumbar puncture shows complete resorption of epidural cerebrospinal fluid collection. Dura mater (arrows) lies close to wall of spinal canal. Note spinal cord (arrowheads).

View larger version (173K): [in a new window]   Fig. 3B. —1-day-old male neonate born at term with cerebrospinal fluid leakage after lumbar puncture. Axial thoracic sonogram shows epidural fluid accumulation (asterisk) with floating fat (F). Note spinal cord (arrowheads) and shifted dura mater (arrows).

View larger version (143K): [in a new window]   Fig. 5A. —6-day-old male neonate born at term with brachial palsy and diaphragmatic paralysis after breech delivery. Longitudinal high-thoracic (A) and midthoracic (B) sonograms show marked epidural cerebrospinal fluid collection (asterisks) due to traumatic cervical meningeal tear tapering caudad to midthoracic level. Note spinal cord (arrowheads) and shifted dura mater (arrows)

View larger version (133K): [in a new window]   Fig. 5B. —6-day-old male neonate born at term with brachial palsy and diaphragmatic paralysis after breech delivery. Longitudinal high-thoracic (A) and midthoracic (B) sonograms show marked epidural cerebrospinal fluid collection (asterisks) due to traumatic cervical meningeal tear tapering caudad to midthoracic level. Note spinal cord (arrowheads) and shifted dura mater (arrows).

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