title: Paradoxical transtentorial herniation caused by lumbar puncture after decompressive craniectomy.
abstract: Although decompressive craniectomy is an effective treatment for various situations of increased intracranial pressure, it may be accompanied by several complications. Paradoxical herniation is known as a rare complication of lumbar puncture in patients with decompressive craniectomy. A 38-year-old man underwent decompressive craniectomy for severe brain swelling. He remained neurologically stable for five weeks, but then showed mental deterioration right after a lumbar puncture which was performed to rule out meningitis. A brain computed tomographic scan revealed a marked midline shift. The patient responded to the Trendelenburg position and intravenous fluids, and he achieved full neurologic recovery after successive cranioplasty. The authors discuss the possible mechanism of this rare case with a review of the literature.
authors.affiliation: Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Korea.
authors.forename: Heyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.forename: Dong Min
authors.initials: DM
authors.lastname: Kim
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim