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KMID : 1001920120510020102
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Journal of Korean Neurosurgical Society
2012 Volume.51 No. 2 p.102 ~ p.104
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Paradoxical Transtentorial Herniation Caused by Lumbar Puncture after Decompressive Craniectomy
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Jung Heyun-Jin
Kim Dong-Min
Kim Seok-Won
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Abstract
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Although decompressive craniectomy is an effective treatment for various situations of increased intracranial pressure, it may be accompanied by several complications. Paradoxical herniation is known as a rare complication of lumbar puncture in patients with decompressive craniectomy. A 38-year-old man underwent decompressive craniectomy for severe brain swelling. He remained neurologically stable for five weeks, but then showed mental deterioration right after a lumbar puncture which was performed to rule out meningitis. A brain computed tomographic scan revealed a marked midline shift. The patient responded to the Trendelenburg position and intravenous fluids, and he achieved full neurologic recovery after successive cranioplasty. The authors discuss the possible mechanism of this rare case with a review of the literature.
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KEYWORD
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Paradoxical herniation, Decompressive craniectomy, Lumbar puncture, Cranioplasty
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