Differential Diagnosis for Pain and Numbness in Left Arm after Lumbar Puncture

• Single most likely diagnosis:
  • Post-dural puncture headache (PDPH) with radicular symptoms: This condition is a common complication of lumbar puncture, where the headache can be accompanied by radicular symptoms such as pain and numbness in the arm due to the pressure changes and potential irritation of nerve roots.
• Other Likely diagnoses:
  • Nerve root irritation or injury: Direct trauma to the nerve roots during the procedure can cause pain and numbness in the arm.
  • Epidural hematoma: Although less common, bleeding into the epidural space can compress nerve roots, leading to pain and numbness.
  • Chemical meningitis: Introduction of blood or other substances into the subarachnoid space during the lumbar puncture can cause an inflammatory response, potentially leading to symptoms including radiculopathy.
• Do Not Miss diagnoses:
  • Spinal epidural abscess: An infection in the epidural space can compress the spinal cord or nerve roots, leading to severe neurological deficits, including pain and numbness in the arm. Early diagnosis is crucial for effective treatment.
  • Spinal hematoma: Similar to an epidural hematoma but located in the spinal cord itself, this condition can cause rapid neurological deterioration and requires immediate intervention.
• Rare diagnoses:
  • Arachnoiditis: Inflammation of the arachnoid membrane can cause symptoms similar to those experienced by the patient, including pain and numbness, though it is less directly related to the lumbar puncture procedure itself.
  • Cervical disc herniation: Although not directly caused by lumbar puncture, the procedure might exacerbate existing conditions, leading to new or worsened symptoms in the arm.