Successful Treatment of Paradoxical Cerebral Herniation by Lumbar Epidural Blood Patch Placement: Technical Case Report

Abstract

Abstract Objective: Death resulting from paradoxical cerebral herniation after the removal of cerebrospinal fluid from the lumbar cistern in a patient with a large craniectomy defect has recently been described. We report a case of successful treatment of this process by placement of a lumbar epidural blood patch. Clinical Presentation: A 19-year-old man underwent a large craniectomy after a motorcycle-related trauma. He subsequently developed a progressive, large subgaleal fluid collection with very mild ventriculomegaly. A lumbar drain was placed, which resulted in paradoxical cerebral herniation. Intervention: The patient was placed in the Trendelenberg position, and a lumbar epidural blood patch was placed. The next morning, there was complete resolution of the midline shift and restoration of visible basal cisterns. The patient has made an excellent recovery. Conclusion: We conclude that paradoxical cerebral herniation can be quickly reversed and successfully treated by placement of a lumbar epidural blood patch.