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Case Reports
. 2017 Aug 2;17(1):147.
doi: 10.1186/s12883-017-0931-1.

Lumbar puncture as possible cause of sudden paradoxical herniation in patient with previous decompressive craniectomy: report of two cases

Liang Shen  1 , Sheng Qiu  1 , Zhongzhou Su  1 , Xudong Ma  1 , Renfu Yan  2   3
Affiliations
Case Reports

Lumbar puncture as possible cause of sudden paradoxical herniation in patient with previous decompressive craniectomy: report of two cases

Liang Shen et al. BMC Neurol. .

Abstract

Background: Lumbar puncture is often used for the diagnosis and treatment of subarchnoid hemorrhage, infection of Cerebro-spinal Fluid (CSF), hydrocephalus in neurosurgery department patients. It is general that paradoxical herniation followed by lumbar puncture is quite rare in decompressive craniectomy cases; the related reports are very few. Moreover, most of the paradoxical herniation cases are chronic, which often occur weeks or even months after the lumbar puncture, to date, barely no reports on the acute onset paradoxical herniation have been found.

Case presentation: Two traumatic brain injury patients with decompressive craniectomy (DC) and hydrocephalus suffered from a sudden paradoxical herniation after lumbar puncture. The symptoms of herniation were improved by treated with Trendelenburg position and rapid intravenous infusion.

Conclusions: Lumbar puncture may have a potential risk of inducing sudden paradoxical herniation in patients with DC. CSF drainage during lumbar puncture should be in small volume for patients with DC. Once a paradoxical herniation occurs after lumbar puncture, an immediate Trendelenburg position and rapid intravenous infusion treatment may be effective.

Keywords: Case report; Decompressive craniectomy; Herniation; Lumbar puncture.

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Conflict of interest statement

Ethics approval and consent to participate

This case report involves two patients. The case report complies with the Helsinki Declaration, and approval was obtained from the ethics committee of Huzhou Central Hospital.

Consent for publication

Written informed consents were obtained from the legal guardian of patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig.1
Fig.1
a A acute subdural hematoma in the left frontotemporal. b A repeated CT two months after the initial surgery. c A progressive hydrocephalus three months later. d, e Three days after placing the patient in a Trendelenburg position and giving sufficient hydration, the patient had a SSFS but no obvious midline shift. f Five years later, hydrocephalus improved itself without cranioplasty or ventriculoperitoneal shunt
Fig. 2
Fig. 2
a A CT after the surgery of subdural hematoma in the frontal temporal lobe cleaning, craniectomy and ventricular drainage. b CT showed a hydrocephalus three-week later after the surgery. c, d The patient had a SSFS and midline shift after the lumbar puncture. e, f After placing the patient in a Trendelenburg positon and giving intravenous fluid, SSFS and midline shift disappeared one day later
See this image and copyright information in PMC

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