NEURO - PATH - Herniation Syndromes

Question 1

Cingulate (subfalcine) herniation under falx cerebri

Answer 1

Can compress anterior cerebral artery

Question 2

Downward transtentorial (central) herniation

Answer 2

Caudal displacement of brain stem–>rupture of
paramedian basilar artery branches–>Duret
hemorrhages

Usually fatal.

Question 3

Uncal herniation

Answer 3

Compresses ipsilateral CN III (blown pupil, “down-andout”
gaze), ipsilateral PCA (contralateral homonymous hemianopia with macular
sparing), contralateral crus cerebri at the Kernohan notch (ipsilateral paresis; a “false
localization” sign)

Question 4

Cerebellar tonsillar herniation into the foramen magnum

Answer 4

Coma and death result when these herniations compress the brain stem