Document Detail


Delayed paradoxical herniation after a decompressive craniectomy: case report.
MedLine Citation:
PMID:  17586009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Paradoxical herniation can occur as a complication of lumbar puncture in patients who had a decompressive craniectomy. The supposed mechanism is the development of a negative pressure gradient that allows the brain to shift toward the infratentorial space with subsequent herniation. Trendelenburg position plus early cranioplasty has been the suggested treatment to eliminate the gradient. CASE DESCRIPTION: A 53-year-old woman had a decompressive hemicraniectomy for SAH-related swelling. A lumbar puncture was performed on postoperative day 5 to rule out infection. She remained neurologically stable until 6 weeks later, when she deteriorated because of a paradoxical herniation. Head positioning and cranioplasty were only temporarily helpful. She developed a second episode of decline a few days later due to an extraaxial CSF collection. A lumbar blood patch plus drainage of the collection successfully allowed full neurologic recovery. CONCLUSIONS: Cranioplasty and head positioning alone might not be sufficient to eliminate the negative pressure gradient. A blood patch should be part of the management of paradoxical herniation.
Authors:
Marcelo Duarte Vilela
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-06-21
Journal Detail:
Title:  Surgical neurology     Volume:  69     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-07     Completed Date:  2008-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  293-6; discussion 296     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. mdvilela@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Craniotomy / methods*
Decompression, Surgical / methods
Encephalocele* / etiology,  radiography,  surgery
Female
Humans
Intracranial Aneurysm / complications
Middle Aged
Postoperative Complications*
Spinal Puncture
Subarachnoid Hemorrhage / etiology,  surgery
Time Factors
Tomography, X-Ray Computed
Ventriculoperitoneal Shunt

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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