Download PDF
Journal of Pediatric Neurology 2022; 20(01): 063-066
DOI: 10.1055/s-0041-1725983
Case Report

Acute Paradoxical Herniation: A Case Report

Vanessa Denny
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
,
Davina Shalev
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
2   Department of Pediatric Neurosurgery, Morristown Medical Center, Morristown, New Jersey, United States
,
Jahannaz Dastgir
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
,
Erin Johnson
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
,
Maria Escobar
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
,
Ma Bernardita Gamallo
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
,
Peter Wynne
3   Department of Radiology, Morristown Medical Center, Morristown, New Jersey, United States
,
Arno Fried
1   Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey, United States
2   Department of Pediatric Neurosurgery, Morristown Medical Center, Morristown, New Jersey, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Decompressive craniectomy is used to relieve acute increased intracranial pressure (ICP) when medical therapy has failed. Paradoxical herniation is a rare complication that occurs when the pressure of the intracranial contents falls abnormally below the atmospheric pressure. Symptoms often include neurological deficits, the etiology of which is often mistaken for elevated ICP. This diagnosis requires quick recognition, and treatment requires a change from ICP reduction therapies to those that increase the ICP, and ultimately cranioplasty.

Keywords

craniectomy - paradoxical herniation - sinking skin flap syndrome


Publication History

Received: 14 December 2020

Accepted: 28 January 2021

Article published online:
16 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Michael AP, Espinosa J. Paradoxical herniation following decompressive craniectomy in the subacute setting. Case Rep Neurol Med 2016; 2016: 2090384
    PubMedGoogle Scholar
  • 2 Akins PT, Guppy KH. Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care 2008; 9 (02) 269-276
    CrossrefPubMedGoogle Scholar
  • 3 Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus 2009; 26 (06) E7
    CrossrefPubMedGoogle Scholar
  • 4 Creutzfeldt CJ, Vilela MD, Longstreth Jr WT. Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting. J Neurosurg 2015; 123 (05) 1170-1175
    CrossrefPubMedGoogle Scholar
  • 5 Yamaura A, Makino H. Neurological deficits in the presence of the sinking skin flap following decompressive craniectomy. Neurol Med Chir (Tokyo) 1977; 17 (1 Pt 1): 43-53
    CrossrefPubMedGoogle Scholar
  • 6 Sakamoto S, Eguchi K, Kiura Y, Arita K, Kurisu K. CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty. Clin Neurol Neurosurg 2006; 108 (06) 583-585
    CrossrefPubMedGoogle Scholar
  • 7 Romero FR, Zanini MA, Ducati LG, Gabarra RC. Sinking skin flap syndrome with delayed dysautonomic syndrome-an atypical presentation. Int J Surg Case Rep 2013; 4 (11) 1007-1009
    CrossrefPubMedGoogle Scholar
  • 8 Kwon SM, Cheong JH, Kim JM, Kim CH. Reperfusion injury after autologous cranioplasty in a patient with sinking skin flap syndrome. J Korean Neurosurg Soc 2012; 51 (02) 117-119
    CrossrefPubMedGoogle Scholar
  • 9 Schwab S, Erbguth F, Aschoff A, Orberk E, Spranger M, Hacke W. [“Paradoxical” herniation after decompressive trephining]. Nervenarzt 1998; 69 (10) 896-900
    CrossrefPubMedGoogle Scholar
  • 10 Cho H, Kim CH, Kim JH. et al. Paradoxical herniation after decompressive craniectomy for acute subdural hematoma. J Korean Neurosurg Soc 2006; 40: 51-53
    PubMedGoogle Scholar
  • 11 Isago T, Nozaki M, Kikuchi Y, Honda T, Nakazawa H. Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty. Ann Plast Surg 2004; 53 (03) 288-292
    CrossrefPubMedGoogle Scholar