Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Decompressive craniectomy is a life-saving procedure for severe intracranial hypertension.
• Paradoxical herniation is a rare but serious complication following decompressive craniectomy.
• Typically, paradoxical herniation occurs weeks to months post-surgery.

Purpose of the Study:

• To report a unique case of paradoxical herniation occurring unusually rapidly after decompressive craniectomy.
• To emphasize the importance of recognizing and promptly managing this complication.

Main Methods:

• Case report presentation.
• Review of clinical presentation, diagnostic findings, and treatment course.
• Discussion of the pathophysiology and management strategies.

Main Results:

• A patient developed paradoxical herniation within days of decompressive craniectomy.
• Standard treatments for intracranial hypertension were found to be contraindicated and potentially harmful.
• Successful management involved repositioning the patient and ensuring adequate hydration.

Conclusions:

• Paradoxical herniation can manifest rapidly after decompressive craniectomy.
• Abrupt neurological deterioration post-surgery warrants immediate investigation for paradoxical herniation.
• Supine positioning and hydration are crucial initial treatments, with cranioplasty as the definitive solution.