II. Causes
- Intracranial Mass
- Cerebral edema
- Intracranial Hemorrhage
III. Mechanism
- Tentorium cerebelli divides supratentorial (Cerebrum) from infratentorial
- Peri-tentorium structures include Midbrain, CN III, medial Temporal Lobe
- Parasympathetic fibers (constrict pupil normally) lie on outside of CN III and are more easily injured
- Oculomotor Nerve (CN III) compression results in Pupil Dilation (Blown Pupil)
IV. Signs
- Unilateral, ipsilateral dilated pupil (Blown Pupil)
- Contralateral limb weakness or Hemiparesis
- Posturing
- Decorticate Posturing (arm flexion)
- Decerebrate Posturing (arm and leg extension)
V. Management
-
General measures
- See Increased Intracranial Pressure in Closed Head Injury
- Includes head of be elevation, airway and Ventilator management, Mannitol
- See Severe Head Injury Management
- See Status Epilepticus
- See Increased Intracranial Pressure in Closed Head Injury
- CNS Hemorrhage (acute Subdural Hematoma, Epidural Hematoma)
VI. References
- (2012) ATLS, ACS p. 152-3
- DeBlieux in Herbert (2016) EM:Rap 16(5): 8-10
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Anatomical Abnormality (T190) |
| ICD10 | G93.5 |
| SnomedCT | 193052001, 63986002 |
| English | Medullary cone, brain stem herniation, brain stem herniation (diagnosis), Herniation of brain (stem), brain herniations stem, coning medullary, medullary cone, brainstem herniation, brain herniation stem, Herniation of brain stem, Herniation of brainstem, Brain stem herniation (disorder), Brain stem herniation, Herniation, brain stem |
| Dutch | hersenuitstulping |
| French | Hernie du tronc cérébral |
| German | Hirnstammhernie |
| Italian | Erniazione del tronco encefalico |
| Portuguese | Hérnia do tronco cerebral |
| Spanish | Hernia del tronco encefálico, herniación del tronco encefálico (trastorno), herniación del tronco encefálico |
| Japanese | 脳幹ヘルニア, ﾉｳｶﾝﾍﾙﾆｱ |
| Czech | Herniace mozkového kmene |
| Hungarian | Agytörzsi beékelődés |
Ontology: Hernia of cerebellar tonsil into foramen magnum (C0393983)
| Concepts | Acquired Abnormality (T020) , Disease or Syndrome (T047) |
| MSH | D004677 |
| SnomedCT | 30759003, 414400006, 413807008, 230755007 |
| English | Hernia of cerebellar tonsil into foramen magnum, Upwards herniat of cerebellum, tonsillar herniation (diagnosis), downward cerebellar herniation, tonsillar herniation, Tonsillar Hernia, Herniations, Cerebellar, Hernias, Tonsillar, Tonsillar Herniations, Cerebellar Hernia, Hernias, Cerebellar, Herniation, Tonsillar, Cerebellar Hernias, Herniations, Tonsillar, Herniation, Cerebellar, Tonsillar Hernias, Hernia, Cerebellar, Cerebellar Herniation, Cerebellar Herniations, Hernia, Tonsillar, Tonsillar Herniation, coning, Herniation tonsillar into foramen magnum, Tonsillar hernia into foramen magnum (disorder), Tentorial herniation, Upwards herniation of cerebellum, Upwards herniation of cerebellum (disorder), Cerebellar hernia, Tonsillar hernia into foramen magnum, Coning, Tonsillar herniation, Cerebellar hernia (disorder), Hernia of cerebellar tonsil into foramen magnum (disorder) |
| Italian | Erniazione tonsillare, Erniazione cerebellare, Ernia cerebellare, Ernia tonsillare |
| Norwegian | Cerebellar herniering, Herniering av tonsilla cerebelli, Cerebellumherniering, Cerebellær herniering, Herniering av lillehjernen |
| Spanish | hernia cerebelosa, hernia amigdalina a través del agujero occipital, hernia amigdalina a través del agujero occipital (trastorno), hernia ascendente del cerebelo (trastorno), hernia ascendente del cerebelo, hernia de amígdala cerebelosa en el agujero magno (trastorno), hernia de amígdala cerebelosa en el agujero magno, hernia de cerebelo (trastorno), hernia de cerebelo |
Ontology: Uncinate herniation (C0393985)
| Concepts | Acquired Abnormality (T020) |
| SnomedCT | 230754006, 89190000 |
| English | uncal herniation, uncal herniation (diagnosis), Uncal herniation, Uncinate herniation, Uncinate herniation (disorder) |
| Spanish | hernia del uncus (trastorno), hernia del uncus |
Ontology: Cerebral herniation (C0553686)
| Concepts | Anatomical Abnormality (T190) |
| SnomedCT | 49453006 |
| Italian | Ernia cerebrale |
| Japanese | 脳ヘルニア, ﾉｳﾍﾙﾆｱ |
| English | cerebral herniation, cerebral herniation (diagnosis), Brain herniation, brain herniation, herniation brain, Hernia cerebri, Cerebral herniation (disorder), Cerebral herniation, brain; herniation, cerebral; herniation, herniation; brain, herniation; cerebral, Herniation, brain |
| Czech | Herniace mozku |
| Hungarian | Az agy herniatiója |
| Dutch | cerebraal; herniatie, herniatie; cerebraal, herniatie; hersenen, hersenen; herniatie, hersenuitstulping |
| Spanish | hernia cerebral, herniación cerebral (trastorno), herniación cerebral, Herniación cerebral |
| Portuguese | Hérnia cerebral |
| French | Hernie cérébrale |
| German | Herniation des Gehirns |
Ontology: Transtentorial hernia (C2937226)
| Concepts | Acquired Abnormality (T020) |
| SnomedCT | 89190000, 230756008 |
| English | central brain herniation, transtentorial herniation (diagnosis), transtentorial herniation, Transtentorial hernia (disorder), Transtentorial hernia, Transtentorial herniation, Transtentorial herniation (disorder), Transtentorial hernia (disorder) [Ambiguous] |
| Spanish | hernia transtentorial (concepto no activo), hernia transtentorial (trastorno), hernia transtentorial |
