Brain Herniation - PubMed

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Excerpt

Brain herniation can be labeled as “brain code” to connate the emergent need to timely counteract such disastrous brain processes.

The brain is encased within the skull, any rise in intracranial pressure is limited to some extent by the compensatory displacement of cerebrospinal fluid (CSF) and changes in cerebral blood volume as evident by the Monro-Kellie doctrine.

When it overrides these compensatory mechanisms, certain parts of the brain start herniating through specific foramina formed by the falx and the tentorial incisura within the skull, thereby propagating progressive herniation syndromes.

Brain herniation is a life-threatening event and needs urgent attention. The five types of brain herniations include:

1. Subfalcine involves the cingulate gyrus, which is pushed against the falx cerebri.

2. Transtenorial (uncal) involves the medial temporal lobe, which is often squeezed by a mass under and across the tentorium.

3. Central involves herniation of both temporal lobes through the tentorial notch.

4. A tonsillar herniation is caused by an infratentorial mass, forcing the cerebellar tonsils through the foramen magnum.

5. Upward herniation occurs when an infratentorial mass compressed the brainstem.

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Conflict of interest statement

Disclosure: Sunil Munakomi declares no relevant financial relationships with ineligible companies.

Disclosure: Joe Das declares no relevant financial relationships with ineligible companies.

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References

1. 1. Stevens RD, Shoykhet M, Cadena R. Emergency Neurological Life Support: Intracranial Hypertension and Herniation. Neurocrit Care. 2015 Dec;23 Suppl 2(Suppl 2):S76-82. - PMC - PubMed
2. 1. Mokri B. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology. 2001 Jun 26;56(12):1746-8. - PubMed
3. 1. Adams CA, Stein DM, Morrison JJ, Scalea TM. Does intracranial pressure management hurt more than it helps in traumatic brain injury? Trauma Surg Acute Care Open. 2018;3(1):e000142. - PMC - PubMed
4. 1. Plum F, Posner JB. The diagnosis of stupor and coma. Contemp Neurol Ser. 1972;10:1-286. - PubMed
5. 1. Papangelou A, Zink EK, Chang WW, Frattalone A, Gergen D, Gottschalk A, Geocadin RG. Automated Pupillometry and Detection of Clinical Transtentorial Brain Herniation: A Case Series. Mil Med. 2018 Jan 01;183(1-2):e113-e121. - PubMed

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