Hazards of Anticoagulation Therapy Shortly After Lumbar Puncture

To the Editor.— Although the risks of lumbar puncture in patients who are receiving anticoagulant therapy is now sufficiently recognized, a note of caution is required for patients who are to receive such therapy shortly after a lumbar puncture. Report of a Case.— A woman, aged 61 years, was admitted to the hospital for pulmonary emboli and a stroke, manifested by left hemiparesis. The latter was considered to be of brain stem origin. Lumbar puncture was performed to rule out a hemorrhagic event, so that she could be placed on anticoagulant therapy for the pulmonary emboli. Two needle punctures were required because of some technical difficulty. The fluid was obtained atraumatically, however, and it contained only a few RBCs. Shortly after lumbar puncture, the patient was placed on a regimen of heparin sodium and warfarin sodium (Coumadin). During the next few days, the patient complained of persistent pain at the