Brain herniation Flashcards
1
Q
!!! What are the types of brain herniation? Associated symptoms?
A
- Subfalcine (aka cingulate): caused by frontal mass, the cingulate gyrus (medial frontal lobe) is forced under the falx cerebri. It is silent unless the anterior cerebral artery is compressed
- Trans-tentorial (aka uncal): lateral supratentorial mass pushes the ipsilateral inferomedial temporal lobe (uncus) through the temporal incisura (free edge of cerebellar tentorium) and against the midbrain. CNIII gets compressed leading to dilated ipsilateral pupil, then ophthalmoplegia. Patients may also have contralateral hemiparesis from pressure on the cerebral peduncle, and coma from pressure on the ascending reticular activating system.
- Tonsillar: posterior fossa pressure forcing cerebellar tonsils through the foramen magnum. Characterised initially by ataxia, CNVI palsy and upgoing plantar reflexes, then loss of consciousness, irregular breathing and apnoea.
