Brain herniation

Question 1

What is an uncal herniation?

Answer 1

Uncus of temporal lobe herniates through tentorium cerebelli, putting pressure on brainstem, esp midbrain

Question 2

What are the signs and symptoms of an uncal herniation?

Answer 2

CN III palsy- down and out eye, fixed and dilated pupil
Visual disturbance- ischaemia of primary visual cortex
Hemiparesis
Brainstem distortion- decorticate posture, res depression

Question 3

What is central herniation?

Answer 3

Diencephalon and temporal lobes herniate through tentorium cerebelli

Question 4

What is the presentation of a central herniation?

Answer 4

Small, fixed pupils and sunset eyes

Death due to haemorrhage of pontine arteries

Question 5

What is a cingulate herniation?

Answer 5

Most common

Cingulate gyrus of frontal lobe is compressed and herniated under falx cerebri to compress the other hemisphere

Question 6

What is a tonsillar herniation?

Answer 6

“coning”

Cerebellar tonsils herniate down through foramen magnum and compress brainstem

Question 7

What is the presentation of tonsillar herniation?

Answer 7

Headache
Head tilt forward and neck stiffness
Decreased LOC
Flaccid paralysis
Resp and cardiac dysfunction
BP instability