Brain herniation in a patient with apparently normal intracranial pressure: a case report

Dahlqvist, Mats B; Andres, Robert H; Raabe, Andreas; Jakob, Stephan M; Takala, Jukka; Dünser, Martin W (2010). Brain herniation in a patient with apparently normal intracranial pressure: a case report. Journal of medical case reports, 4, p. 297. London: BioMed Central

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Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg). Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Dahlqvist, Mats Börje; Andres, Robert; Raabe, Andreas; Jakob, Stephan; Takala, Jukka and Dünser, Martin Wolfgang

ISSN:

1752-1947

Publisher:

BioMed Central

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:09

Last Modified:

09 Dec 2014 10:11

PubMed ID:

20807427

BORIS DOI:

10.7892/boris.966

URI:

https://boris.unibe.ch/id/eprint/966 (FactScience: 201576)

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