A 42-year-old man on ICU with traumatic brain injury has an ICP of 32 mmHg despite first and second-tier medical therapies. The neurosurgical team per...

Question

A 42-year-old man on ICU with traumatic brain injury has an ICP of 32 mmHg despite first and second-tier medical therapies. The neurosurgical team performs a decompressive craniectomy. Post-operatively, ICP falls to 12 mmHg. On day 3 post-craniectomy, the team notes paradoxical herniation of brain tissue through the craniectomy defect when the patient is positioned upright. What phenomenon is this?

Accepted Answer

Syndrome of the trephined (sinking skin flap syndrome) - atmospheric pressure on the exposed brain causing paradoxical herniation when upright

Answer

Normal post-craniectomy brain swelling

Answer

Recurrent intracranial haematoma

Answer

Hydrocephalus

Answer

Fat embolism syndrome

uk-fficm MCQ (SBA): Syndrome of the Trephined