Post craniectomy paradoxical brain herniation: a case report with radiological review

Authors

  • Sanjay M. Khaladkar Department of Radiodiagnosis, Dr D.Y Patil Medical College and research Centre, Pimpri, Pune, Maharashtra, India
  • Raunak Raj Department of Radiodiagnosis, Dr D.Y Patil Medical College and research Centre, Pimpri, Pune, Maharashtra, India
  • Rajul Bhargava Department of Radiodiagnosis, Dr D.Y Patil Medical College and research Centre, Pimpri, Pune, Maharashtra, India
  • Rohan Khujat Department of Radiodiagnosis, Dr D.Y Patil Medical College and research Centre, Pimpri, Pune, Maharashtra, India
  • Amaya Mahajan Department of Radiodiagnosis, Dr D.Y Patil Medical College and research Centre, Pimpri, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20163824

Keywords:

Meningogaleal complex, Mesodiencephalic dysfunction, Post craniectomy, Paradoxical brain herniation, Sinking flap syndrome

Abstract

Sinking skin flap (SSF) syndrome and paradoxical brain herniation are rare complications after craniectomy. On CT scan, there is shrunken appearance of the skin flap at craniectomy site. The meningogaleal complex is drawn inwards and is resting on underlying deformed brain with resultant concave surface. It results due to altered CSF hydrodynamics. Paradoxical brain herniation is rare complications which occur in patients who undergo cerebrospinal fluid (CSF) drainage procedures like lumbar puncture (LP), external ventricular drainage, ventriculo-peritoneal shunting and post craniectomy. Its early detection on imaging is essential as it is a neurosurgical emergency. We report a case of 75 year old male previously operated for left chronic subdural hematoma in the left fronto-temporo-parietal region presenting with altered consciousness and inability to walk. Plain CT scan showed craniectomy defect in the left fronto-temporo-parietal region with indrawing of meningogaleal complex suggestive of Shrunken Skin Flap. There was mass effect on the left lateral ventricle and third ventricle with shift of the midline structures towards right (1cm) with evidence of subfalcine herniation suggestive of paradoxical brain herniation.

References

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Published

2016-12-19

How to Cite

Khaladkar, S. M., Raj, R., Bhargava, R., Khujat, R., & Mahajan, A. (2016). Post craniectomy paradoxical brain herniation: a case report with radiological review. International Journal of Research in Medical Sciences, 4(11), 5085–5086. https://doi.org/10.18203/2320-6012.ijrms20163824

Issue

Section

Case Reports