Published: Sunday, November 21, 2010, 4:50 AM
In the past decade, Cuyahoga County judges have dismissed 364 cases mid-trial because they said prosecutors failed to provide the most basic evidence to sustain a conviction.
The Plain Dealer examined those cases. The judges’ rulings indicate that county Prosecutor Bill Mason’s office has pushed hundreds of marginal criminal cases to trial in the past decade.
Profiles: The people behind the cases
|What critics say||What Mason says|
|Defense attorneys say it appears that Mason’s office lacks a filter to screen weak cases from entering courtrooms, and they stress that those cases clog an already overburdened justice system. The 364 cases represent about 5 percent of the criminal trials from 2000 to 2009. That’s one dismissal in every 19 trials. That doesn’t include the number of cases where the charges are sharply reduced, in many cases from felonies to misdemeanors.
Critics say the issue begins with overburdened police officers, who investigate crimes and push their reports — which sometimes need more work — to supervisors and municipal prosecutors. The cases then reach Mason’s office, where grand jury prosecutors review the cases, and present them to secret panels.
The grand juries seldom balk at prosecutors’ recommendations, a point that many critics of the system stress. They say the grand jury is no longer an independent panel, but a working arm of the prosecutor’s office.
|Mason says his office routinely kicks back about 600 cases a year to local police departments because of a lack of evidence. The grand jury also throws out about 400 cases.
He also points to his 92 percent conviction rate. He said if defendants do not accept plea offers, it is incumbent on his office to hold people accountable. They present the facts and let judges and juries decide.
Mason also placed some of the blame for those numbers on judges. His office stressed a common baseball analogy of an umpire. What might look like a strike to one umpire is a ball to another.
In other words, one judge may see a case and allow it to go to a jury without any problems, believing prosecutors have presented enough evidence. Another judge may demand a higher threshold of evidence.
Mason’s office also pointed out that six judges accounted for nearly 40 percent of the dismissals.
November 24th, 2010
The Daily Mail (http://www.dailymail.co.uk/heal…) have announced that the UK have decided to give toddlers vaccines for six diseases at once. David Derbyshire a journalist for the Mail says:
“Toddlers are to be inoculated against six diseases at once in a bid to boost vaccination rates, the Government revealed yesterday”
“The ‘super-vaccination’ day will involve three injections to protect against measles, mumps, rubella, two forms of meningitis and bacteria that can cause pneumonia.”
The vaccines to be used in the UK’s three shot ‘super vaccination’ day are the MMR, PCV and the Hib/Men C.
This unusual and controversial move was on the advise of the Joint Committee of Vaccination and Immunisation (JCVI), an organization that sanctions and approves the vaccine policies in the UK. According to the Mail, the committee’s research shows that combining multiple vaccines on one day would cause no health problems. The Government believes the change will simplify the complicated vaccine schedule and boost the uptake of vaccines after the MMR scare in 1998.
However, many professionals are unhappy that the JCVI are now controlling the vaccine policies in the UK. The Child Health Safety website (http://childhealthsafety.wordpress.com…) have called the JCVI ‘needle happy and reckless’,saying that they have serious concerns over conflicts of interest.
“Giving the JCVI control over vaccination policy appears little different to giving control directly to the drug industry”
Child Health Safety continue:
“The JCVI is drawn from the British Medical professions and includes members with drug industry financial conflicts of interest [Declarations of Interests] and an historically poor record to the present day on vaccination and child health safety [revealed in Freedom of Information documentation ”
Paul Offit from the University of Pennsylvania stated in 2005 that in ‘theory’, a baby’s immune system can cope with having as many a 100,000 vaccines in one go, although he did change this later to 10,000. This was said when he was promoting the Pediarix vaccine a five in one vaccine, containing hepatitis B, polio, tetanus, diphtheria, and pertussis (whooping cough vaccine). (http://www.whale.to/vaccines/offit23.html)
I feel it is important to point out at this point that Paul Offit also has conflicts of interest. He is a member of the CDC advisory committee and has disclosed that he received $350,000 grant money from Merck to develop the rotavirus vaccine, in which he shares the patent, which was pulled 6 months after is was licensed because of severe problems. The Wall Street Journal has said that Dr Offit gets paid to go around the country teaching doctors that vaccines are safe. (http://www.lawyersandsettlements.com…)
Ginger Taylor a writer, speaker, advocate, activist, and therapist and owner of the blog ‘Adventures in Autism’ calls Offit ‘A poster child for medical conflicts of interest.’ In an email to Mr. Huvane and Mr Kranzler (http://adventuresinautism.blogspot.com…) she said:
“Further, Paul Offit was personally reprimanded by the U.S. Congress, at length, for his ethics problems. He actually sat on the ACIP, the CDC committee that decides what vaccines go on the US schedule, and voted for RotaShield to be added to the schedule, knowing full well that it would pave the way for his own vaccine, Rotateq to be added and be immediately put into wide spread use as soon as it came to market. Which is exactly what happened. Offit should have abstained from any comments or votes on any thing to do with Rota virus because of his conflicts of interest.
Paul Offit is the poster child for medical conflicts of interest.
When you take vaccine advice from him, it is as if you called Merck to ask if their products cause autism.”
According to the Parents PACK October 2005 (http://www.whale.to/vaccine/…) Offit said:
“Children have an enormous capacity to respond safely to challenges to the immune system from vaccines. A baby’s body is bombarded with immunologic challenges – from bacteria in food to the dust they breathe. Compared to what they typically encounter and manage during the day, vaccines are literally a drop in the ocean.”
Having just shown that Dr Offit has an ulterior motive for promoting vaccines, just how safe is vaccinating a baby with six vaccines in one go? According to Neil Z Miller a medical research journalist and natural health advocate, not very. In his booklet, Overdosed Babies – Are Multiple Vaccines Safe? (http://thinktwice.com/overdose.pdf) he likens multiple vaccines to the equivalent of pouring 3 shot glasses of whiskey, gin and rum into one glass. He explains that you even though the shots are in one glass you are still ingesting 3 alcoholic drinks – not just one – with all the anticipated side effects.
Taking this into account a baby having six vaccines in a single paediatric visit, is the equivalent to the baby receiving six different drugs on one day. Also the baby will be subjected to not just one but three painful shots in one go which is extremely traumatic for a young child.
It was stated in the book ‘Vaccines’ that Dr Offit contributed to however:
“Studies of cortisol concentration and behavioral responses of infants to vaccination indicate that responses are similar in infants who receive two injections during one visit and those who receive a single injection, suggesting that a second injection does not increase stress.” Vaccines, 4th ed. pp. 103.
This statement is totally misleading, as a young child will scream just as loudly whether they have had one, two or twenty two vaccines and to say differently is ridiculous.
Due to new evidence recently revealed, the UK government is in fact deceiving parents. It has now been revealed that multiple vaccinations in one go are not as safe as they would want us to believe. The UK government are fully aware of this fact.
On the 27th October 2010 some very disturbing news came to light. The website WDDTY revealed that recent evidence discovered by a journalist on FOI (Freedom Of Information) shows that forty children have died in the UK after routine vaccinations such as the MMR. Another 2,100 children have suffered a serious reaction. This came to light when the UK were forced to disclose the information.
WDDTY (http://www.wddty.com/40-uk-children…) say:
“The UK’s Medicine and Healthcare Products Regulatory Authority (MHRA) was forced to reveal the figures following a request from a journalist under freedom of information legislation.”
“It is suspected that just 10 per cent of all deaths and reactions from vaccines are ever reported; if so, this means that 400 children have died from a vaccine and 21,000 have suffered an adverse reaction in the UK alone.”
Despite knowing these alarming facts, the UK government are still saying that multi vaccinations are safe and effective. They are lying to parents by saying these vaccines are safe when clearly they are not. The government are fully aware that vaccine injuries are under reported and that these vaccines are killing possibly hundreds of children. However, instead of looking into these alarming figures and discovering why so many children are dying or being injured after a vaccine, they are more intent on pushing vaccine uptake. Once again they are seen putting profit before the health and safety of UK’s children.
- Vaccines have destroyed lives for decades and the UK Government tried to cover it up
- Parents criticize government for not acting sooner
- Hidden Government Papers on the Measles Vaccine Exposed
- The lies the Government tell when it comes to vaccines
- U.S. Government to Americaâ€™s Vets: Drop Dead
- The British Government refuse to compensate health workers who become ill after conditional vaccines
- Parents Continue to Support Doctor Andrew Wakefield
A TEN-day-old baby was put in care and his young mother arrested when a bump on his head was misdiagnosed as child abuse, it was reported today.
Dee Crawford, 19, was told to take her newborn Michael back to hospital after she noticed a swelling, which she believed might have happened when he fell against scales at her home in Chester-le-Street, County Durham.
A doctor at the University Hospital of North Durham examined the baby and reported the injury as new, leading to the police and social services being informed.
Ms Crawford was arrested on suspicion of assault and questioned by police before being released on bail.
Meanwhile, Michael was taken away and placed in care, as his mother collapsed in tears.
He had been born by caesarean section just ten days previously on January 19, weighing 9lb 8oz.
Police allowed Ms Crawford to read the doctor’s report and, when she was allowed home, she used the internet to research what was claimed against her.
She challenged the doctor’s assertion that Michael’s swelling could not be a cephalohematoma regularly caused during labour – as, according to him, they never occur with caesarean section births.
The authorities sought further expert advice, and a paediatric specialist from the Royal Victoria Infirmary ruled the swelling was undoubtedly the result of the difficult labour.
Michael was returned to his mother after spending two-and-a-half weeks apart.
Ms Crawford said: “What happened to me I wouldn’t wish on my worst enemy.
“I have lost time with my baby when I should have been bonding with him, and Ill never get that back.”
She admitted the authorities had put Michael on the Child Protection Register before he was born, saying that was due to her depression.
A Durham Police spokesman said: “We can confirm that a 19-year-old woman has been arrested on suspicion of assault on February 4, but no further action has since been taken against her.”
A Durham County Council spokeswoman said: “For reasons of confidentiality, it is not appropriate for us to comment on individual cases.
“However, we would never consider removing a child from a family in the context of a suspected injury without first taking expert medical advice.
This story was taken from a news source on the 19th February 2009. Though the zeal and need to protect children is well placed the margin of error needs to be addressed. Taking a child who is not being abused from its biological parents is also damaging to the child and greater efforts must be taken to avoid common errors in misdiagnosing and over diagnosing child abuse.
Physician, Surrey, BC
By Edward Markovich
Akron Courts Examiner
On November 15, 2010 the State of Ohio will begin to try the case of young Tiffani Calise in Akron, Ohio for the crime of allegedly shaking a baby to death. The charge is involuntary manslaughter, and child endangering. The case is somewhat incoherent, either she hurt the baby bad enough to cause its death or she didn’t. If she did, it seems a case of simple homicide, until you examine the shaky basis of so-called shaken baby syndrome.
For the past quarter of a century, medical professionals have routinely been taught that shaking a baby can cause injuries so severe that irreversible brain damage or death will likely result from the act of shaking alone. In Akron, Childrens’ Hospital’s Dr. Steiner has specialized in diagnosing and testifying regarding alleged cases of shaken infants, resulting in past convictions of young parents and caregivers. But international courts, most recently in Canada and Great Britain, have called for a review of all shaken baby convictions on the basis of new scientific data undermining its reliability as a forensic medical diagnosis.
In American courts, the rule of admissibility of expert scientific opinions follows the case of Daubert v. Merrill Dow Pharmaceuticals, 509 U.S. 579 (1993) . The United States Supreme Court held in that case that the enactment of the Federal Rules of Evidence impliedly overturned the earlier Frye rule. In a 1923 case, Frye v. United States, 293 F. 1013 (D.C. Cir. 1923), the court held that evidence could be admitted in court only if “the thing from which the deduction is made” is “sufficiently established to have gained general acceptance in the particular field in which it belongs.” After Daubert changes in medical science can be admitted even before all opinions have agreed in one scientific area.
In 2008, a Wisconsin jury convicted Audrey Edmunds of murdering her baby by shaking, and she was sentenced to eighteen years in prison. On January 31, 2008, Audrey Edmunds was granted a new trial on the basis of new scientific thinking. For the first time, a court examining the foundation of shaken baby syndrome held that it had become sufficiently shaky itself that a new jury probably would have a reasonable doubt as to the defendant‘s guilt. As the United States Supreme Court emphasized in Daubert v. Merrell Dow Pharmaceuticals, Inc., ―[v]igorous cross-examination, presentation of contrary evidence, and careful instruction on the burden of proof are the traditional and appropriate means of attacking shaky but admissible evidence.
Could it be that shaken-baby syndrome has become itself such a shaky, negative forensic diagnosis, (meaning it attaches to the last person who happened to be caring for the child when it loses consciousness), that Ohio doesn’t have the heart to charge her with murder? In Tiffani Scalise’s case, she happened to be babysitting for the baby who died later from alleged shaking. Although involuntary manslaughter is much less serious than intentional or negligent homicide, it seems that her case may depend not just on facts and law, but on a growing awareness that past cases of infant death may have been decided on a very shaky scientific foundation, which is now under reconstruction.
OBA Conference April 9, 2010
You can get mixed messages reading too many advocacy manuals and texts1. For example, some will advise you when opening at trial to be thorough and heavy on the documents, and others will advise you to be short and sweet. In closing some will advise you to make limited written submissions in a fashion akin to bullet points and others will advise you to file a detailed written statement both at the beginning and end of trial.
Some people recommend that you make detailed oral and written submissions covering every material point. Others will recommend that your submissions should be limited in scope so as to allow the judges to develop the argument for themselves: on the psychological basis that a judge’s own thoughts are more likely than your submissions to be incorporated in the judgment. The plethora of advocacy-related education courses and programs would suggest that advocacy skills can be learned. I believe this is true to a certain extent or this paper would not be useful.
Nonetheless, the lifeblood of advocacy is experience. And a lot of experience is a prerequisite to being a successful advocate.
This article further examines the experience and the style of defense lawyers. It will take you through the tactics in timing utilizing case samples for consideration as well as laying out five points of advice when seeking to expedite a trail.
Should you or should you not make an objection and what are some of the common objections made? When should you challenge an expert?
Page 10 of this article:
The Goudge Report (2008)20 on flaws in Ontario’s forensic pathology system had much broader implications for civil and criminal justice in Ontario. It sets out fertile ground for objections to expert evidence. In the context of criticizing the pathologist, Dr. Smith, the Inquiry identified 10 criticisms, all of which can be relevant in any case:
(i) he failed to understand his role was not to support the crown (or party
retaining him) (this goes to bias and may affect both weight and
(ii) he failed to adequately prepare for court (this would be relevant to the
weight of his evidence);
(iii) he overstated his knowledge in a particular area (this may be relevant to
his qualification as an expert or to weight);
(iv) he gave anecdotal evidence which was inappropriately unscientific (this
goes primarily to the weight of his evidence);
(v) he failed to give a balanced view of the evidence and was dogmatic and
was unduly certain (this again goes more to weight);
(vi) he was unprofessional and gave unwarranted criticism of other
professionals (this again goes more to weight);
(vii) he testified on matters outside his area of expertise (this should be the
subject of an immediate objection);
(viii) he gave opinions which were speculative, unsubstantiated and not based
on (pathology) findings (this goes to weight);
(ix) he used loose and unscientific language (again, this goes to weight); and
(x) he lacked candour and honesty (again, this goes to weight).
The Goudge Inquiry established that the complexities of forensic pathology often led to ineffective cross-examination. You must be thoroughly prepared in the particular area of expertise to perform a competent cross-examination.
This article will also take you through your written submissions before and after the evidence has gone in. It will assist in providing direction for both opening statements and closing arguments.
How can one utilize the transcript fully for cross examination purposes? Examine twelve suggestions for this.
There is also an array of excellent resources attached and labeled Schedule A as well as examples of transcripts in the section labeled Schedule B.
Page 35 of article:
The Death Of A Child And The Criminal Justice System
This explains the devastation and impact involved on the families who have lost a child coupled with the travesty of being wrongfully accused of being responsible for it.
Dr. Charles Smith is rightly used as an example of medical misdiagnosis complicating an already difficult time for a family. What was his role as an expert and what were his failings in providing evidence?
The article explores ten of these pertinent failings, which not only permeated the cases Dr. Smith was involved in but have been repeated with so many other so called expert evidence.
Page 40 provides an analysis on the roles of the Coroners, Police, Crown and Defense and then moves on in Page 41 to give insight as to the role the court plays. Seven points are elaborated on regarding ways to assist the court with this oversight.
Regarding wrongful convictions on Page 42 I quote:
In my view there is one set of cases in which further review is justified. Simply put, the changes in pathology knowledge concerning shaken baby syndrome and pediatric head injures over the last two decades provide cogent reasons for a carefully constructed review of these cases.
For full PDF article please see Source:
It has been reported that 28.6% of Canada’s children and youths are vulnerable to physical and/or emotional injury. These statistics were stated by the information website Child Abuse Effects. The Canadian Child Welfare Research Portal reported that in 2007 an estimated 67,000 children were in out-of-home care across Canada. The figures shown in a briefing document Child protection statistics: A UK comparison for children referred to child protection were unbelievable in the UK in the same year, with England being as high as 545,000, Wales 49,561 and Scotland 11,960. In the USA the U.S. Department of Health & Human Services Administration for Children and Families Administration on Children, Youth and Families Children´s Bureau wrote a report entitled Child Maltreatment 2006 which reported that: “During Federal fiscal year 2006, an estimated 3.3 million referrals, involving the alleged maltreatment of approximately 6.0 million children, were made to CPS agencies.” Out of these an estimated 905,000 children were determined to be victims of abuse or neglect. Interestingly the report states that: “Children in the age group of birth to 1 year had the highest rate of victimization at 24.4 per 1,000 children of the same age group in the national population” These figures although slightly out of date are staggering but how many of the children in care today have actually been taken from loving caring families? One would hope none of them had but sadly this is not the case. Some children it appears are taken from families who are loving and caring because the child protection system has got it wrong. Parents from around the world are saying that they have been falsely accused of child abuse after their child has become sick through no fault of their own. This article tells the tragic story of one such family.
Tess was born a healthy baby and became a healthy toddler. She was meeting all her milestones and her parents Michele and Barry were very proud of their beautiful daughter. However, in the summer of 2002 things took an unexpected turn. Tess then aged six years old became very ill, she lost her speech and began to deteriorate. Tess was not alone, Michele and Barry also became very ill with a combination of diarrhoea, vomiting, dizziness and burning to the throats. The whole family developed a terrible cough. Tess developed a terrible rash and began to have a series of seizures. Their illness was a complete mystery. Despite tests the doctors were at a loss. It wasn’t until a William A. Croft M.D., diagnosed arsenic poisoning that things began to drop into place.
A repair man visiting the family home to check their air condition had pointed out that he could see chemicals leaking out of the wood on their decking. Michele and Barry had recently had a brand new decking erected in their garden ironically so that Tess could play safely under the watchful eye of her mother. Unbeknown to them the decking similar to many deckings being used at the time was treated with chromated copper arsenate (CCA), usually recognisable from it’s greenish tinge. This treatment was used to protect the wood to kill bugs and bacteria, however because of it’s arsenic content it was highly dangerous and for this reason CCA has been since discontinued. The Pesticides: Regulating Pesticides 2008 said: “Chromated copper arsenate (CCA) is a chemical wood preservative containing chromium, copper and arsenic. CCA is used in pressure treated wood to protect wood from rotting due to insects and microbial agents. EPA has classified CCA as a restricted use product, for use only by certified pesticide applicators. CCA has been used to pressure treat lumber since the 1940s. Since the 1970s, the majority of the wood used in outdoor residential settings has been CCA-treated wood. Pressure treated wood containing CCA is no longer being produced for use in most residential settings, including decks and playsets”.
Sadly this information came too late for Tess and her family who were already very ill with arsenic poisoning. The symptoms of arsenic poisoning taken from the website wiseGeek are extensive and include stomach pain, bowel pain, tenderness and pressure on the body, retching, vomiting, excess saliva, a dry or tight throat, lethargy, thirst and weakness. A hoarse voice, encephalopathy, coma, speech changes or difficulty speaking, diarrhea, a burning sensation while urinating, tenesmus, problems with the anus, cramps, convulsions, cold or clammy sweats, purplish-red skin, a sunken face, red eyes and delirium may indicate poisoning.
Dr Croft said that the family were suffering from acute and chronic arsenic exposure from the wood. The deck was condemned as a health hazard and was removed shortly afterwards However the families problems did not end there. Despite this and a report stating that “Barry, Michele and Tess have undergone and will require to undergo extensive hospital, medical surgical, therapeutic and pharmacological treatment” things began to deteriorate and Michele became under suspicion of munchausen’s by proxy. Munchausen Syndrome by Proxy or MSBP is a diagnosis given to a mother or care giver to describe aspects of their behaviour. This behaviour usually includes subjecting what appears to be a previously healthy child to unnecessary and often painful tests or medical interventions i.e.: scans, x-rays and even surgical procedures to gain attention from the medical profession. Tess became subject to child protection procedures. This came as a complete shock to the family because all medical reports had clearly stated that the problems Michele reported were very real. One report presented to child protection about Tess’s condition stated the following: “In 2000 the medical records show a development of skin rashes , numbness, tingling. G.I complaints, behaviour and cognition activities and seizures.” Reports consistently showed a history of seizures, allergies, anaphylactic allergic reactions requiring an epi pen (described as a peanut allergy), fine motor problems, difficulties with spatial awareness, ADHD, thyroid abnormalities the list wass endless. Tess’s thyroid condition was identified in 2008 as being Hashimoto’s thyroiditis. These complaints were clearly not made up or exaggerated as report after report describe the same things. One report in 2008 states “Thyroid antibodies persist” the same report states “Tess’s medical problems are all consistent with exposures to arsenic and chromium that occurred in the 2002 period”.Due to Tess’s allergies, Tess was exempt from receiving her vaccinations however, she was vaccinated against her mother’s wishes with the MMR and straight away her problems increased. Michele says “She immediately deteriorated developing hives”. Tess began to lose eye contact and slowly her lovely smile faded. Last year Tess was removed from the family home and taken into care. Michele was said to suffer from MSBP, she was described as very anxious and on occasions as depressed. Hardly surprising after the catastrophic series of events. Michele is devastated and angry. She says “This was no way to treat a family, it never ends, MSbP for exposure? Your heart breaks, as you watch them struggle with brain fog and bowel issues, school grades drop.. and its a simple thyroid titer issue, known to be caused by arsenic….. EPI PENS denied.. BY doctors and child protection. WHO IS PROTECTED the CHILD?” Doctors repeated time and time again that Michele responded appropriately. Tess was described in the child care reports as being happy and did not present an anxious child. She had a variety of friends and was doing well at school. Tess had described her condition as ‘reactions’ which required an Epi. The CAS could not conclude that Tess was at risk from harm due to emotional abuse. So what was Tess at risk from exactly? Sadly Michele not only lost the child she adores but also her marriage and her home. N.B I have been given full permission to use reports and photos by Michele. I have used Christian names only to protect the family and have not identified which country they come from.
Meningitis and subarachnoid hemorrhage are serious
life-threatening conditions. They require prompt
and accurate diagnosis in the Emergency Department
due to their significant morbidity and mortality. There
are many diagnostic modalities available to the Emergency
Physician to assist in the diagnosis. However, lumbar
puncture (LP) is still considered the gold standard.
Lumbar puncture is a procedure that is often performed
in the Emergency Department to obtain information
about the cerebrospinal fluid (CSF) to aid in the diagnosis
of a variety of medical conditions. Knowledge about
the proper indications, contraindications, various techniques,
equipment, and recognition and treatment of
its complications is vital to any physician that performs
A lumbar puncture should be performed
after a thorough neurological exam. Significant
morbidity and mortality can result if the procedure
is performed on the wrong patient.
CHAPTER 96 / LUMBAR PUNCTURE 873
Traumatic lumbar puncture is a common occurrence.
Up to 72 percent of lumbar punctures have anywhere
from 1 to over 50 red blood cells.78 This is a common and
usually uncomplicated occurrence in patients with normal
coagulation. Traumatic lumbar puncture can result in
a spinal epidural or spinal subdural hematoma in patients
with coagulation abnormalities. Epidural hematomas
most likely result from needle trauma to the internal vertebral
plexus or radicular vessels (Figure 96-10).78 The
radicular vessels course down the length of each nerve
root. It has been suggested that the bevel of the spinal needle
can induce trauma and bleeding to these vessels much
like they produce paresthesias when touching the nerve
Subdural or subarachnoid hemorrhage is a rare but
catastrophic complication in patients with a coagulopathy.
Edelson et al recommend that the procedure be
performed only if absolutely necessary in patient’s
with thrombocytopenia.79 Platelets should be transfused
prior to lumbar puncture in patients with platelet
counts less than 20,000 or if platelet counts are dropping
rapidly. The most skilled physician should perform the
lumbar puncture using a 22 gauge (or smaller) needle.79
Patients should be observed after the procedure for the
development of neurological signs suggesting a hematoma.
Such signs include paraplegia, lower extremity
weakness, sensory deficits, or incontinence.
Another rare bleeding complication is an intracranial
subdural hematoma.80,81 This may result from the same
mechanism causing PDPH, namely downward displacement
of the brain from decreased CSF volume and persistent
leakage after lumbar puncture. This may occasionally
cause tearing of the bridging veins and lead to a
unilateral or bilateral subdural hematoma.
Most lumbar punctures will be performed in suspected
cases of meningitis or for subarachnoid hemorrhage
after a negative head CT. The risks of performing a
lumbar puncture need to be weighed against the potential
benefits of diagnosing these two potentially lifethreatening
illnesses promptly. Knowledge of the proper
indications, contraindications, technique, and interpretation
of the CSF findings will undoubtedly help the
physician to minimize the complications that can be associated
with the procedure. Although most complications
are rare, awareness of their existence, presentation,
and proper treatment is imperative for any physician
that performs this procedure.
For entire PDF article please see Source: