SANFORD E. WARREN
To the editor: The short article by Laglia and colleagues, "Spinal Epidural Hematoma after Lumbar Puncture in Liver Disease" (1), publicizes a clinical problem one often encounters in obtunded alcoholic patients with abnormalities of hemostasis and coagulation: namely, assessment of risk with spinal puncture. After exclusion of increased intracranial pressure (such as due to a subdural hematoma) by funduscopic examination and, if focal neurologic signs are present, of a mass lesion by diagnostic radiography, spinal puncture is both indicated and safely performed in most cases. Laglia and associates make recommendations they believe will minimize the risk of hemorrhage in this
WARREN SE. Epidural Hematoma from Lumbar Puncture. Ann Intern Med. ;89:431. doi: 10.7326/0003-4819-89-3-431_1
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Published: Ann Intern Med. 1978;89(3):431.
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