Cerebral Herniation


Cerebral Herniation, Uncinate Herniation, Uncal Herniation, Brainstem Herniation, Brain Stem Herniation, Cerebellar Herniation, Transtentorial Herniation, Acute Severe Intracranial Pressure Management

  • Mechanism
  1. Tentorium cerebelli divides supratentorial (Cerebrum) from infratentorial
  2. Peri-tentorium structures include Midbrain, CN III, medial Temporal Lobe
    1. Parasympathetic fibers (constrict pupil normally) lie on outside of CN III and are more easily injured
    2. Oculomotor Nerve (CN III) compression results in Pupil Dilation (Blown Pupil)
  • Signs
  1. Unilateral, ipsilateral dilated pupil (Blown Pupil)
  2. Contralateral limb weakness or Hemiparesis
  3. Posturing
    1. Decorticate Posturing (arm flexion)
    2. Decerebrate Posturing (arm and leg extension)
  • Management
  • References
  1. (2012) ATLS, ACS p. 152-3
  2. DeBlieux in Herbert (2016) EM:Rap 16(5): 8-10