SDH after LP

Case: 34 years old male is admitted to ICU with symptoms of possible meningitis. The resident on call decided to perform Lumbar Puncture (LP). Post-procedure, patient complains of severe headache. CT head showed subdural hematoma (SDH). What is the mechanism of Subdural hematoma after LP? 

Answer: 

Any iatrogenic cause of cerebrospinal fluid leak leads to low cerebrospinal fluid pressure. This intracranial hypotension decreases the buoyancy of the brain. Decrease buoyancy causes traction on the anchoring and supporting structures including bridging veins. It leads to the tearing of these vessels. Moreover, intracranial hypotension directly causes the cerebral veins engorgement and leakage of fluid into the subdural space.

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References:

1. Abdullah M, Elkady A, Bushnag A, Seddeq Y, Alkutbi A. Acute Subdural Haemorrhage as a Complication of Diagnostic Lumbar Puncture. Cureus. 2020;12(4):e7515. Published 2020 Apr 2. doi:10.7759/cureus.7515

2. Kim HJ, Cho YJ, Cho JY, Lee DH, Hong KS. Acute subdural hematoma following spinal cerebrospinal fluid drainage in a patient with freezing of gait. J Clin Neurol. 2009;5(2):95-96. doi:10.3988/jcn.2009.5.2.95