Post-craniotomy asymmetrical brain sag presumably caused by decreased cerebrospinal fluid production

Shinya Kobayashi, Kohei Yoshikawa, Takuro Endo, Masaki Maeda, Jun Tanabe, Junta Moroi, Tatsuya Ishikawa

Research output: Contribution to journalArticlepeer-review


Brain sag may result from post-craniotomy over-drainage or the leakage of cerebrospinal fluid. We treated a patient in whom it was caused not by the loss of cerebrospinal fluid but by its decreased production. A 72-year-old man who had previously undergone gastrectomy underwent a right superficial temporal artery to middle cerebral artery bypass. On postoperative Day 8 he lapsed into a coma and imaging showed a midline shift, and craniotomy was therefore performed again. However, there were no signs of elevated intracranial pressure, and a diagnosis of brain sag due to low cerebrospinal fluid pressure was reached. The blood concentration of retinol-binding protein was low, and decreased cerebrospinal fluid production due to vitamin A deficiency was indicated to be the cause. The patient improved after conservative treatment consisting of vitamin A supplementation. This condition should be borne in mind in the event of unexpected impairment of consciousness or if indicated by imaging findings after craniotomy.

Original languageEnglish
Pages (from-to)599-605
Number of pages7
JournalJapanese Journal of Neurosurgery
Issue number8
Publication statusPublished - 2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology


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