Brain herniation syndromes


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