Document Detail

Successful treatment of paradoxical cerebral herniation by lumbar epidural blood patch placement: technical case report.
MedLine Citation:
PMID:  17876219     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Death resulting from paradoxical cerebral herniation after the removal of cerebrospinal fluid from the lumbar cistern in a patient with a large craniectomy defect has recently been described. We report a case of successful treatment of this process by placement of a lumbar epidural blood patch. CLINICAL PRESENTATION: A 19-year-old man underwent a large craniectomy after a motorcycle-related trauma. He subsequently developed a progressive, large subgaleal fluid collection with very mild ventriculomegaly. A lumbar drain was placed, which resulted in paradoxical cerebral herniation. INTERVENTION: The patient was placed in the Trendelenberg position, and a lumbar epidural blood patch was placed. The next morning, there was complete resolution of the midline shift and restoration of visible basal cisterns. The patient has made an excellent recovery. CONCLUSION: We conclude that paradoxical cerebral herniation can be quickly reversed and successfully treated by placement of a lumbar epidural blood patch.
Joshua Seinfeld; Michael Sawyer; Craig H Rabb
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Publication Detail:
Type:  Case Reports; Journal Article; Technical Report    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-18     Completed Date:  2007-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E175; discussion E175     Citation Subset:  IM    
Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204-4507, USA.
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MeSH Terms
Blood Patch, Epidural / methods*
Craniotomy / adverse effects*
Drainage / adverse effects*
Encephalocele / etiology*,  therapy*
Lumbar Vertebrae
Treatment Outcome

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

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