Emergency Medicine Book


Cerebral Herniation

Aka: Cerebral Herniation, Uncinate Herniation, Uncal Herniation, Brainstem Herniation, Brain Stem Herniation, Cerebellar Herniation, Transtentorial Herniation, Acute Severe Intracranial Pressure Management
  1. See Also
    1. Increased Intracranial Pressure in Closed Head Injury
    2. Severe Head Injury Management
    3. Increased Intracranial Pressure Causes
  2. Causes
    1. Intracranial Mass
    2. Cerebral edema
    3. Intracranial Hemorrhage
      1. Epidural Hematoma
      2. Acute Subdural Hematoma
  3. 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)
  4. 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)
  5. Management
    1. General measures
      1. See Increased Intracranial Pressure in Closed Head Injury
        1. Includes head of be elevation, airway and Ventilator management, Mannitol
      2. See Severe Head Injury Management
      3. See Status Epilepticus
    2. CNS Hemorrhage (acute Subdural Hematoma, Epidural Hematoma)
      1. See Skull Trephination
  6. References
    1. (2012) ATLS, ACS p. 152-3
    2. DeBlieux in Herbert (2016) EM:Rap 16(5): 8-10

Brain stem herniation (C0270679)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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