Herniations Flashcards
are patients conscious with herniations?
NEVER
name the four types of brain herniations
uncal
central
tonsillar
cingulate
where does a cingulate brain herniation occur?
supratentorial portion of the brain
a cingulate supratentorial herniation leads to what change in CSF?
ventricles become compressed
how does cingulate herniation lead to coma and death?
it actually causes a downward central herniation then uncal herniation and ultimately a tonsillar herniation and these can compress the brain stem
what artery is at risk with cingulate herniation?
ACA
ACA ischemia in cingulate hernation causes what symptom?
weakness of contralateral leg
where is a central (transtentorial) herniation located?
mid region of brain on side usually
what does a central herniation lead to with brainstem?
caudal displacement of diencephalon, midbrain and pons
what does a central herniation cause with vessels?
stretches/shears paramedian perforating vessels (branches of basilar)
what can the shearing/stretching of perforating vessels in a central herniation lead to?
duret hemorrhages
what is a duret hemorrhage?
small hemorrhage in the midbrain or pons
what herniation leads to duret hemorrhage
central transtentorial herniation
what will you see on CT with duret hemorrhage?
small white area in middle of cortex
where is an uncal herniation found?
medial temporal lobe on same side as lesion
where does an uncal herniation go?
into tentorial notch of the tentorium cerebelli
what does an uncal herniation compress? 2 things
ipsilateral midbrain and ipsilateral CN III
what are symptoms of uncal herniation? 3 things
contralateral weakness of motor movement
dilated ipsilateral pupil
decreased level of consciousness
what is a tonsillar herniation?
herniation of tonsils of cerebellum out foramen magnum
what does tonsillar herniation compress?
brainstem
what does tonsillar herniation lead to?
flaccidity in muscles, coma, changes in respirations, pulse and BP
