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

Mats B Dahlqvist1, Robert H Andres2, Andreas Raabe2, Stephan M Jakob1, Jukka Takala1 and Martin W Dünser1*

Author Affiliations

1 Department of Intensive Care Medicine, Bern University Hospital and University of Bern, Bern, Switzerland

2 Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland

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Journal of Medical Case Reports 2010, 4:297  doi:10.1186/1752-1947-4-297

Published: 31 August 2010



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.


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.