Head of the Bed Down: Paradoxical Management for Paradoxical Herniation
Emergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient wit...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2019-08-01
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| Series: | Clinical Practice and Cases in Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/3zr0h4ft |
| _version_ | 1818278844888514560 |
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| author | Patrick D. Bender Alisha E.C. Brown |
| author_facet | Patrick D. Bender Alisha E.C. Brown |
| author_sort | Patrick D. Bender |
| collection | DOAJ |
| description | Emergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient with previous hemicraniectomy. The symptomatology was similar to cerebral herniation from intracranial hypertension and included lethargy, bradycardia, headache, and compression of brain structures on non-contrast head computed tomography. However, contrary to treatment modalities for intracranial hypertension, our management strategy aimed to reverse intracerebral hypotension. Treatment for paradoxical herniation involved increasing intracranial pressure using fluid resuscitation and Trendelenburg positioning. In the intensive care unit our patient received an epidural blood patch and hydration with resolution of his symptoms. |
| first_indexed | 2024-12-12T23:23:54Z |
| format | Article |
| id | doaj.art-6fbe09e8853549eeb275addf78125bd8 |
| institution | Directory Open Access Journal |
| issn | 2474-252X |
| language | English |
| last_indexed | 2024-12-12T23:23:54Z |
| publishDate | 2019-08-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Clinical Practice and Cases in Emergency Medicine |
| spelling | doaj.art-6fbe09e8853549eeb275addf78125bd82022-12-22T00:08:10ZengeScholarship Publishing, University of CaliforniaClinical Practice and Cases in Emergency Medicine2474-252X2019-08-013310.5811/cpcem.2019.4.41331cpcem-3-208Head of the Bed Down: Paradoxical Management for Paradoxical HerniationPatrick D. BenderAlisha E.C. BrownEmergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient with previous hemicraniectomy. The symptomatology was similar to cerebral herniation from intracranial hypertension and included lethargy, bradycardia, headache, and compression of brain structures on non-contrast head computed tomography. However, contrary to treatment modalities for intracranial hypertension, our management strategy aimed to reverse intracerebral hypotension. Treatment for paradoxical herniation involved increasing intracranial pressure using fluid resuscitation and Trendelenburg positioning. In the intensive care unit our patient received an epidural blood patch and hydration with resolution of his symptoms.https://escholarship.org/uc/item/3zr0h4ft |
| spellingShingle | Patrick D. Bender Alisha E.C. Brown Head of the Bed Down: Paradoxical Management for Paradoxical Herniation Clinical Practice and Cases in Emergency Medicine |
| title | Head of the Bed Down: Paradoxical Management for Paradoxical Herniation |
| title_full | Head of the Bed Down: Paradoxical Management for Paradoxical Herniation |
| title_fullStr | Head of the Bed Down: Paradoxical Management for Paradoxical Herniation |
| title_full_unstemmed | Head of the Bed Down: Paradoxical Management for Paradoxical Herniation |
| title_short | Head of the Bed Down: Paradoxical Management for Paradoxical Herniation |
| title_sort | head of the bed down paradoxical management for paradoxical herniation |
| url | https://escholarship.org/uc/item/3zr0h4ft |
| work_keys_str_mv | AT patrickdbender headofthebeddownparadoxicalmanagementforparadoxicalherniation AT alishaecbrown headofthebeddownparadoxicalmanagementforparadoxicalherniation |