Paradoxical Brain Herniation: An Unexpected Diagnosis.
| Autor: | Amaral IM; Intensive Care Unit, Unidade Local de Saúde do Santo António, Porto, PRT., Sousa S; Neurosurgery, Unidade Local de Saúde do Santo António, Porto, PRT., Martins J; Critical Care, Unidade Local de Saúde Tâmega e Sousa, Penafiel, PRT., Castro H; Intensive Care Unit, Unidade Local de Saúde do Santo António, Porto, PRT. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2024 Jul 03; Vol. 16 (7), pp. e63723. Date of Electronic Publication: 2024 Jul 03 (Print Publication: 2024). |
| DOI: | 10.7759/cureus.63723 |
| Abstrakt: | Paradoxical herniation is a dreadful neurosurgical complication often underdiagnosed, which typically becomes evident over the course of weeks to months after the initial intervention. Here we present a unique case with manifestations in the post-operative period. A patient initially referred to neurosurgery for a meningioma underwent an uneventful surgical excision, followed by the transient placement of a lumbar drain for 48 hours. On the first post-operative day, the patient exhibited progressively altered neurological status, with corresponding imaging revealing a transfalcine herniation, necessitating emergent decompressive craniectomy. Despite the medical and surgical interventions, there were continuous signs of neurological and imaging worsening, with increase in herniation, which led to the diagnosis suspicion of a paradoxical brain herniation. Consequently, a rapid reversal of neurological deficits was observed after applying maneuvers to augment the intracranial pressure, followed by cranioplasty. This case illustrates the utmost importance of clinical suspicion for the uncommon complications of neurointerventions. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Amaral et al.) |
| Databáze: | MEDLINE |
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