Intracranial epidural hematoma after lumbar puncture in a patient with sickle cell disease: A rare case report

• What is already known about this topic? • Sickle cell disease is associated with various neurological complications, including ischemic stroke and intracranial hemorrhage. • Intracranial hemorrhage in patients with sickle cell disease most commonly involves the subarachnoid space, whereas epidural hematoma remains exceptionally rare. • Lumbar puncture can, in rare cases, lead to intracranial bleeding, most commonly subdural hematoma secondary to cerebrospinal fluid hypotension. • What does this study add to the literature? • To our knowledge, this is the first reported case of intracranial epidural hematoma following lumbar puncture in a patient with sickle cell disease. • It highlights the potential interplay between sickle cell–related bone fragility and intracranial hypotension following lumbar puncture in the development of epidural hematoma. • This case underscores the need for close neurological monitoring after lumbar puncture in patients with sickle cell disease, particularly during vaso-occlusive crises. Sickle cell disease (SCD) is associated with various neurological complications, including ischemic stroke and intracranial hemorrhage, though epidural hematomas remain extremely rare. Lumbar puncture (LP) is a commonly performed diagnostic procedure, but its association with intracranial epidural hematoma in SCD has not previously been reported. A 19-year-old male with homozygous sickle cell disease presented with acute chest syndrome and meningeal signs. A lumbar puncture was performed to rule out meningitis. A few hours later, he developed sudden neurological deterioration with decreased level of consciousness and left hemiplegia. Brain MRI revealed a large right convexity epidural hematoma. Emergency craniotomy was performed with complete evacuation of the hematoma. No skull fracture or bleeding source was identified. The patient made a full neurological recovery. To our knowledge, this is the first reported case of intracranial epidural hematoma following lumbar puncture in a patient with sickle cell disease. It suggests a potential interplay between CSF hypotension and sickle cell-related bone fragility. Close neurological monitoring after lumbar puncture may be warranted in this population.