Brain herniation syndromes

Types

Type of brain herniation

1. Uncal
   • Blown pupil (third nerve palsy, compression from uncus into tentorium cerebelli
   • Hemiparesis/babinski (75% contralateral)
2. Central Transtentorial
   • Pinpoint → nonresponsive midpoint pupils
   • Motor weakness → increased tone → flexor, then extensor posturing
3. Cerebellotonsilar (posterior fossa pressure)
   • Pinpoint pupils
   • Sudden respiratory and cardiovascular collapse
   • Flaccid quadriplegia
4. Upward Transtentorial
   • Pinpoint pupils
   • Downward conjugate gaze
5. Subfalcine herniation (cerebral mass lesion causes medial surface of affected hemisphere to push against rigid falx cerebri, then herniate underneath)
   • Cingulate gyrus most commonly affected
   • Often clinically silent

See Also

• Elevated intracranial pressure
• Head trauma (main)
• Intracranial hemorrhage (main)