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Case Reports in Neurological Medicine
Volume 2016, Article ID 2090384, 3 pages
Case Report

Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

Department of Surgery, Division of Neurosurgery, Southern Illinois University School of Medicine, P.O. Box 19645, Springfield, IL 62794-9645, USA

Received 14 May 2016; Accepted 12 June 2016

Academic Editor: Abbass Amirjamshidi

Copyright © 2016 Alex P. Michael and Jose Espinosa. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option.