1988 Volume 28 Issue 6 Pages 601-603
An elderly male became semicomatose, with aggravation of right hemiparesis, due to massive air collection in the subdural space immediately after craniotomy for wrapping of an aneurysm. A subdural tap disclosed very low pressure within the cranial cavity. The neurological manifestations were not caused by tension pneumocephalus, but were presumed to be secondary to downward deviation of the brain parenchyma. Rapid resolution of the neurological signs was achieved by replacement of the air with saline. In this pathological condition, which has been referred to as “sunken brain syndrome, ” neurological symptoms develop secondarily to downward displacement of the brain parenchyma. This complication should be kept in mind as a neurosurgical risk in patients with brain atrophy.