title: Cerebral herniation as a complication of chest tube drainage of cerebrospinal fluid after injury to the spine.
abstract: BACKGROUND
  Patients with concomitant injuries to the thorax and thecal sac requiring chest tube drainage are at risk for cerebral herniation caused by overdrainage of cerebrospinal fluid (CSF).
  
  
  METHODS
  A 40-year-old man presented to the trauma service awake, alert, and oriented with an isolated gunshot wound to the midaxillary line through the tenth intercostal space and a complete spinal cord injury at T12. The patient was stabilized and intubated. A chest tube was placed, and he was transferred to the neurologic intensive care unit. The patient was found to be comatose with complete absence of brainstem reflexes 3 hours after admission.
  
  
  RESULTS
  Magnetic resonance imaging (MRI) and autopsy revealed diffuse cerebral edema, occlusion of the bilateral posterior cerebral arteries, and tonsillar herniation extending several centimeters below the foramen magnum, with petechial hemorrhages and absence of gliosis.
  
  
  CONCLUSIONS
  To the authors' knowledge, this case represents the first report of cerebral herniation secondary to chest tube drainage of a CSF leak caused by traumatic injury to the thecal sac.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: M Yashar S
authors: MY
authors: Kalani
authors: Aristotelis
authors: A
authors: Filippidis
authors: Nikolay L
authors: NL
authors: Martirosyan
authors: Nicholas
authors: N
authors: Theodore
mesh_terms: D000328:Adult; D001926:Brain Death / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology; D002552:Cerebral Ventricles / Q000473:pathology; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications* / Q000473:pathology; D015505:Chest Tubes / Q000009:adverse effects*; D004487:Edema / Q000473:pathology*; D004677:Encephalocele / Q000473:pathology*; D017809:Fatal Outcome; D005539:Foramen Magnum / Q000473:pathology; D006491:Hemothorax / Q000473:pathology / Q000601:surgery*; D006801:Humans; D020767:Intracranial Thrombosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology; D013119:Spinal Cord Injuries / Q000473:pathology / Q000601:surgery*; D013396:Suction / Q000009:adverse effects*; D013898:Thoracic Injuries / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000473:pathology; D014948:Wounds, Gunshot / Q000473:pathology / Q000601:surgery*