Lumbar drainage (LD) is considered as a simple and effective procedure for the treatment of intracerebral hemorrhage with ventricular involvement. However, cerebrospinal fluid overdrainage and hypovolemia due to LD could induce severe fatal complications, which include transtentorial herniation and infratentorial hemorrhage. Here, we describe a 63-year-old man with transtentorial herniations and Duret hemorrhage attributable to LD after the operation of thalamic hematoma removal. This is probably the first reported case of severe complications of LD. Thus, complications related to transtentorial herniations and Duret hemorrhage should be kept in mind while performing LD.