Sir, We read with interest the article "Paradoxical herniation caused by cerebrospinal fluid drainage after decompressive craniectomy" by Wang el al. and commend the authors on highlighting this uncommon complication after decompressive craniectomy (DC). Though the term "paradoxical herniation" was first used by Schwab et ah in 1998, there is no clarity on what is "paradoxical" about this herniation and we feel the term is redundant. Cerebral herniations always occur along a pressure gradient (from high to low and never the other way around) and the cases described in literature as "paradoxical" are no exception to this rule.
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