Paradoxical Brain Herniation: An Unexpected Diagnosis

Area of Science:

• Neurosurgery
• Neurology

Background:

• Paradoxical herniation is an uncommon yet serious complication following neurosurgical procedures.
• It typically manifests weeks to months after intervention, but can present earlier.

Observation:

• A patient developed transfalcine herniation on the first post-operative day after meningioma excision and lumbar drain placement.
• Neurological status and imaging showed progressive worsening despite decompressive craniectomy.

Findings:

• Diagnosis of paradoxical brain herniation was suspected due to persistent neurological decline.
• Reversal of deficits occurred after interventions to increase intracranial pressure, followed by cranioplasty.

Implications:

• This case highlights the importance of high clinical suspicion for paradoxical herniation in the early post-operative period.
• Early recognition and management are vital for improving outcomes in this rare complication.