• Joshua Seinfeld, Michael Sawyer, and Craig H Rabb.
• Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado 80204-4507, USA.
• Neurosurgery. 2007 Sep 1; 61 (3 Suppl): E175; discussion E175.

ObjectiveDeath resulting from paradoxical cerebral herniation after the removal of cerebrospinal fluid from the lumbar cistern in a patient with a large craniectomy defect has recently been described. We report a case of successful treatment of this process by placement of a lumbar epidural blood patch.Clinical PresentationA 19-year-old man underwent a large craniectomy after a motorcycle-related trauma. He subsequently developed a progressive, large subgaleal fluid collection with very mild ventriculomegaly. A lumbar drain was placed, which resulted in paradoxical cerebral herniation.InterventionThe patient was placed in the Trendelenberg position, and a lumbar epidural blood patch was placed. The next morning, there was complete resolution of the midline shift and restoration of visible basal cisterns. The patient has made an excellent recovery.ConclusionWe conclude that paradoxical cerebral herniation can be quickly reversed and successfully treated by placement of a lumbar epidural blood patch.

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