Myelogram Leads to Punctured Spinal Cord and Paralysis

It is important to avoid lumbar puncture in patients where the disease process has progressed to a point in which neurologic findings may be associated with impending cerebral herniation (ie, deteriorating level of consciousness and brainstem signs that include pupillary changes, posturing, irregular respirations, and very recent seizure). Cerebral herniation is the most serious complication of a lumbar puncture. It is very rare, and there is considerable debate in the literature regarding whether it is caused by the lumbar puncture or by the underlying disease process. There is increasing evidence that a diagnostic lumbar puncture is safe even in patients with increased intracranial pressure (ICP), such as most patients with meningitis, but there is no firm consensus regarding the safety of lumbar puncture in patients with ICP.