Delayed spinal subarachnoid hematoma: a rare complication of C1-C2 cervical myelography.

The lateral C1-C2 needle insertion for cervical myelography is a valuable alternative to lumbar puncture and is considered a safe procedure. Mullen et al. [1] initially described this approach for cervical cordotomy and later Kelly and Alexander [2] adopted this technique for visualization of the spinal canal and its contents. Mullen early reported transient paresis and vertebral artery embolus as complications of this technique. Inadvertent puncture of the cervical cord and injection of contrast medium into the cord have also been reported as rare complications [3-6]. Only one instance of hemorrhage after C1-C2 puncture has been reported, in a patient with leukemia and a coagulopathy disorder [7]. In all patients with complications, symptoms were immediate and responded to either needle withdrawal , contrast resorption , or surgical intervention. We report a case of hemorrhage after C1-C2 puncture, in which symptoms were late and bleeding was localized to the cervical subarachnoid space. To our knowledge, our patient is the first reported case of cervical subarachnoid hematoma that complicated C1-C2 puncture for cervical myelography and that required surgical decompression.