Coexistent of paradoxical herniation and subdural hygroma: a case report

Abstract

Background: Coexistent of paradoxical herniation and subdural hygroma (SDG) is very rare, confusing symptoms may mislead the therapies. Case presentation: We report a case of a 33-year-old man underwent decompressive craniectomy (DC), postoperatively, the patient developed progressive neurologic deterioration and midline shift opposite to the DC window, CT scan revealed a SDG beside the DC window, instead of attributing the midline shift to the SDG, we recognized the underlying paradoxical herniation according to the sunken skin flap and history of lumbar cistern drainage. Subsequently we treat him with intravenous fluid expansion therapy instead of draining from the SDG, the patient recovered in one day and no recurrence was found later. Conclusion: For patients underwent DC, we should pay attention to the occurrence of paradoxical herniation, SDG following DC may be the consequence of paradoxical herniation caused by CSF reduce therapy in post-DC patient, intravenous fluid expansion therapy is recommended and would play a great role for the recovery of the patient rather than surgical management.

Brain herniation and subsequent complications following partial resection of high‐grade glioma: A case report

“…The pathogenesis of SDH is not well understood. However, the most likely explanation is the tearing of the subarachnoid layer leading to the ball valve opening resulting in unidirectional cerebrospinal fluid (CSF) flow into subdural space, forming SDH 6,7 …”

“…However, the most likely explanation is the tearing of the subarachnoid layer leading to the ball valve opening resulting in unidirectional cerebrospinal fluid (CSF) flow into subdural space, forming SDH. 6,7 Neurosurgical procedures are associated with higher morbidity and mortality as compared to any other surgical procedure. 2 In this case report, we discuss the pathogenesis and management strategies of BH, wound infection, CSF leak, ipsilateral SDH, floating bone flap, and communicating hydrocephalus in an adult patient following partial resection of high-grade glioma.…”