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{
    "pk": 668,
    "title": "Head of the Bed Down: Paradoxical Management for Paradoxical Herniation",
    "subtitle": null,
    "abstract": "Emergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient with previous hemicraniectomy. The symptomatology was similar to cerebral herniation from intracranial hypertension and included lethargy, bradycardia, headache, and compression of brain structures on non-contrast head computed tomography. However, contrary to treatment modalities for intracranial hypertension, our management strategy aimed to reverse intracerebral hypotension. Treatment for paradoxical herniation involved increasing intracranial pressure using fluid resuscitation and Trendelenburg positioning. In the intensive care unit our patient received an epidural blood patch and hydration with resolution of his symptoms.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3zr0h4ft",
    "frozenauthors": [
        {
            "first_name": "Patrick",
            "middle_name": "D.",
            "last_name": "Bender",
            "name_suffix": "",
            "institution": "University of Washington, Harborview Medical Center, Department of Emergency Medicine, Seattle, Washington",
            "department": "None"
        },
        {
            "first_name": "Alisha",
            "middle_name": "E.C.",
            "last_name": "Brown",
            "name_suffix": "",
            "institution": "University of Washington, Harborview Medical Center, Department of Emergency Medicine, Seattle, Washington",
            "department": "None"
        }
    ],
    "date_submitted": "2019-04-02T21:44:45+01:00",
    "date_accepted": "2019-04-02T21:44:45+01:00",
    "date_published": "2019-05-29T19:41:41+01:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/668/galley/427/download/"
        }
    ]
}