Cerebral herniation
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The document discusses cerebral herniation, which refers to the shift of cerebral tissue from its normal location into an adjacent space due to mass effect from traumatic, neoplastic, ischemic, or infectious causes. There are several types of cerebral herniation including subfalcine, transalar, transtentorial, tonsillar, and extracranial herniation. Subfalcine herniation, the most common type, is characterized by the displacement of brain tissue beneath the free edge of the falx cerebri due to increased intracranial pressure.
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Cerebral herniation syndromes
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
Brain herniation
- Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to increased intracranial pressure. This is a medical emergency.
- Common causes are cerebral edema, hematoma, stroke, tumor, and infections.
- There are several types of cerebral herniations including subfalcine, central, uncal, and tonsillar. Uncal herniation can cause pupillary dilation and decreased consciousness as it compresses the midbrain.
- Increased intracranial pressure can be managed medically with positioning, hyperventilation, hyperosmolar therapy, and induced hypertension or surgically with decompressive craniectomy.
Brain herniation imaging
This document discusses different types of brain herniation seen on imaging. The most common types are subfalcine herniation and descending transtentorial herniation. Subfalcine herniation occurs when one hemisphere pushes across the midline under the falx cerebri. Descending transtentorial herniation occurs when the temporal lobe and hippocampus herniate through the tentorial incisura. Other types discussed include tonsillar herniation, ascending transtentorial herniation, and rare transdural herniations. Complications of herniations include hydrocephalus, nerve compression, and infarcts.
Herniation Syndromes
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
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Cerebral herniation syndromes
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
Brain herniation
- Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to increased intracranial pressure. This is a medical emergency.
- Common causes are cerebral edema, hematoma, stroke, tumor, and infections.
- There are several types of cerebral herniations including subfalcine, central, uncal, and tonsillar. Uncal herniation can cause pupillary dilation and decreased consciousness as it compresses the midbrain.
- Increased intracranial pressure can be managed medically with positioning, hyperventilation, hyperosmolar therapy, and induced hypertension or surgically with decompressive craniectomy.
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This document discusses different types of brain herniation seen on imaging. The most common types are subfalcine herniation and descending transtentorial herniation. Subfalcine herniation occurs when one hemisphere pushes across the midline under the falx cerebri. Descending transtentorial herniation occurs when the temporal lobe and hippocampus herniate through the tentorial incisura. Other types discussed include tonsillar herniation, ascending transtentorial herniation, and rare transdural herniations. Complications of herniations include hydrocephalus, nerve compression, and infarcts.
Herniation Syndromes
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
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The Dandy-Walker complex is a rare congenital brain malformation characterized by cystic dilation of the 4th ventricle and partial or complete absence of the cerebellar vermis. It ranges from mega cisterna magna to Dandy-Walker variant to Dandy-Walker malformation based on severity. Associated anomalies are common. The cause is unknown but likely involves abnormal development of the hindbrain. Treatment involves managing hydrocephalus, often with shunt procedures. Prognosis depends on severity and associated anomalies, with higher mortality and developmental delays in more severe forms.
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The surgical importance of the meninges lies in their role as protective barriers and their involvement in certain medical conditions and procedure.
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Cerebellum
This case describes a patient who suffered a cerebellar infarction after a motorcycle accident without a helmet. Some key points:
- Initial CT was normal but follow up CT showed a large left cerebellar infarction and obstructive hydrocephalus.
- He underwent an emergency suboccipital craniectomy and decompression which allowed for recovery.
- Now, 48 hours later, he is becoming progressively drowsy with vomiting.
My thoughts on what is happening and next steps:
1. He is likely experiencing increased intracranial pressure from edema and hydrocephalus related to the large cerebellar infarction.
2. I would obtain an emergent CT to re-evaluate for worsening
Presentation1.pptx, ultrasound examination of the neonatal head.
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common pathologies of brain.pptx
This document discusses several common pathologies seen in the brain:
1. Trauma such as epidural hematomas, subdural hematomas, subarachnoid hemorrhage, and diffuse axonal injury are described along with their imaging appearances on CT and MRI.
2. Strokes including cerebral infarction, intraparenchymal hemorrhage, and subarachnoid hemorrhage are outlined.
3. Infections like meningitis, abscesses, tuberculomas, and neurocysticercosis are covered.
4. Demyelinating diseases like multiple sclerosis are mentioned.
5. Tumors both extra-axial and intra
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Head Trauma Ct Evaluation
CT is the most important imaging modality for evaluating head trauma. It can detect fractures, extra-axial hemorrhages such as epidural hematomas and subdural hematomas, subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhages. Common primary traumatic brain injuries seen on CT include contusions, diffuse axonal injury characterized by small hemorrhages, and deep cerebral and brainstem injuries. MRI can provide additional details, especially in the subacute and chronic stages.
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Cerebral herniation
- 1. CEREBRAL HERNIATION DR SUMIYA ARSHAD
- 3. INTRODUCTION Cerebral herniation, also referred to as acquired intracranial herniation, refers to shift of cerebral tissue from its normal location, into an adjacent space as a result of mass effect.
- 4. ETIOLOGY Any mass effect from traumatic, neoplastic, ischemic, or infectious etiologies.
- 5. TYPES Subfalcine herniation Transalar herniation: ascending and descending Transtentorial herniation o Downward: uncal herniation o Upward: ascending transtentorial herniation Tonsillar herniation Extra cranial herniation
- 6. SUBFALCINE HERNIATION The most common cerebral herniation pattern. Characterized by displacement of the brain (typically the cingulate gyrus) beneath the free edge of the falx cerebri due to raised intracranial pressure.
- 8. RADIOGRAPHIC FEATURES CT Cingulate gyrus is pushed from one side to other underneath the anterior falx. Asymmetry at the anterior falx Widened CSF spaces on the contralateral anterior falx. Ipsilateral lateral ventricle compression with contralateral lateral ventricular dilation.
Editor's Notes
- Each category of herniation is associated with a specific neurologic syndrome
- Subfalcine herniation, the most common cerebral herniation pattern, is characterised by displacement of the brain (typically the cingulate gyrus) beneath the free edge of the falx cerebri due to raised intracranial pressure
- Nonenhanced head computed tomography scan at the level of the suprasellar cistern in the same patient as in the previous image. A large right frontotemporal subdural hematoma is exerting mass effect on the right frontal and temporal lobes, with resultant effacement of the suprasellar cistern and with right-sided uncal herniation. Mass effect from the subdural hematoma effaces the ipsilateral temporal horn, causing dilatation of the contralateral temporal horn. Subfalcine herniation and narrowing of the contralateral ambient and quadrigeminal plate cisterns are present.
- Nonenhanced head computed tomography (CT) scan at the level of the lateral ventricles was obtained in a 78-year-old man who presented with respiratory failure. The image demonstrates a large right frontal and temporal subdural fluid collection with hyperattenuating and hypoattenuating components consistent with an acute on chronic subdural hematoma. Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and enlargement of the contralateral occipital horn are present.
- The easiest method of evaluating for subfalcine shift is a straight line drawn in the expected location of the septum pellucidum from the posterior most aspects to the falx on axial images. Shift of the septum pellucidum from this midline can be measured in millimeters and compared over time to determine any change.