A 79-year-old woman with a history of chronic atrial fibrillation and acenocoumarol therapy was admitted to the intensive care unit because of persistent coma after a first episode of seizures. A brain computer tomography was normal and her temperature was 39°C. After administration of prothrombin complex concentrate and standardization of coagulation index, a lumbar puncture was performed. The procedure was difficult due to the presence of spondyloarth-rosis. Empiric antibiotic therapy for bacterial meningitis was started with good clinical response. The patient recovered without neurological sequelae and could be extubated within a few days. There were no further seizures episodes during intensive care unit stay. Deep venous thrombosis prophylaxis with subcutaneous enoxaparin 40 mg/d was reinstituted 24 hours after lumbar puncture.
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