Abstract
MRI from a comatose patient with a massive acute subdural haematoma showed most of the features of transtentorial herniation described in the classic pathology literature. In addition to encroachment on the perimesencephalic cisterns, infarction in the anterior and posterior cerebral artery territories, ischaemic change in the lower diencephalon, and ventricular enlargement were visualised. Despite the clinical syndrome and these secondary changes due to compression, there was only approximately 2 mm of downward displacement of the upper brainstem compared with 13 mm horizontal displacement. Although tissue shifts adjacent to the tentorial aperture cause brainstem and vascular compression, these changes may occur with minimal downward herniation.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blinkov S. M., Gabibov G. A., Tanyashin S. V. Variations in location of the arteries coursing between the brain stem and the free edge of the tentorium. J Neurosurg. 1992 Jun;76(6):973–978. doi: 10.3171/jns.1992.76.6.0973. [DOI] [PubMed] [Google Scholar]
- Cohen A. R., Wilson J. Magnetic resonance imaging of Kernohan's notch. Neurosurgery. 1990 Aug;27(2):205–207. doi: 10.1097/00006123-199008000-00005. [DOI] [PubMed] [Google Scholar]
- Feldmann E., Gandy S. E., Becker R., Zimmerman R., Thaler H. T., Posner J. B., Plum F. MRI demonstrates descending transtentorial herniation. Neurology. 1988 May;38(5):697–701. doi: 10.1212/wnl.38.5.697. [DOI] [PubMed] [Google Scholar]
- Hahn F. J., Gurney J. CT signs of central descending transtentorial herniation. AJNR Am J Neuroradiol. 1985 Sep-Oct;6(5):844–845. [PMC free article] [PubMed] [Google Scholar]
- Marinković S. V., Milisavljević M. M., Lolić-Draganić V., Kovacević M. S. Distribution of the occipital branches of the posterior cerebral artery. Correlation with occipital lobe infarcts. Stroke. 1987 Jul-Aug;18(4):728–732. doi: 10.1161/01.str.18.4.728. [DOI] [PubMed] [Google Scholar]
- Niikawa S., Uno T., Ohkuma A., Hara A., Nokura H., Yamada H. [Occlusion of a perforating artery, by descending tentorial herniation after head injury, supplying deep cerebral structure--report of 4 cases and their CT evaluation]. No To Shinkei. 1988 Dec;40(12):1151–1156. [PubMed] [Google Scholar]
- Osborn A. G. Diagnosis of descending transtentorial herniation by cranial computed tomography. Radiology. 1977 Apr;123(1):93–96. doi: 10.1148/123.1.93. [DOI] [PubMed] [Google Scholar]
- Ropper A. H. A preliminary MRI study of the geometry of brain displacement and level of consciousness with acute intracranial masses. Neurology. 1989 May;39(5):622–627. doi: 10.1212/wnl.39.5.622. [DOI] [PubMed] [Google Scholar]
- Rothfus W. E., Goldberg A. L., Tabas J. H., Deeb Z. L. Callosomarginal infarction secondary to transfalcial herniation. AJNR Am J Neuroradiol. 1987 Nov-Dec;8(6):1073–1076. [PMC free article] [PubMed] [Google Scholar]
- Sato M., Tanaka S., Kohama A., Fujii C. Occipital lobe infarction caused by tentorial herniation. Neurosurgery. 1986 Mar;18(3):300–305. doi: 10.1227/00006123-198603000-00007. [DOI] [PubMed] [Google Scholar]
- Sohn D., Levine S. Frontal lobe infarcts caused by brain herniation. Compression of anterior cerebral artery branches. Arch Pathol. 1967 Nov;84(5):509–512. [PubMed] [Google Scholar]
- Stovring J. Descending tentorial herniation: findings on computed tomography. Neuroradiology. 1977 Dec 14;14(3):101–105. doi: 10.1007/BF00333050. [DOI] [PubMed] [Google Scholar]