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Brain Herniation: A Revision of Classical Concepts

Published online by Cambridge University Press:  18 September 2015

C. Miller Fisher
C. Miller Fisher*
Affiliation:
Neurology Service, Massachusetts General Hospital., Boston
*
Neurology Service, Massachusetts General Hospital, Boston, MA USA 02114
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Abstract

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This paper is an update on evolving ideas about brain herniations. Following observations on cerebellar pressure coning that raised doubts about its reputed lethal connotations, herniation at the tentorium was re-examined for its role in critically damaging the brain stem. Combining clinical, pathologic, computed tomography and magnetic resonance imaging data, it is concluded that temporal lobe herniation is not the means by which the midbrain sustains irreversible damage in acute cases, but rather lateral displacement of the brain at the tentorium is the prime mover and herniation a harmless accompaniment. Transtentorial herniation has been investigated with computed tomography using the three calcification relationship and descent through the tentorial opening could not be documented. Bilateral brain stem compression in acute bilateral cases must be distinguished from herniation. Upward cerebellar herniation is only the sign of an overfull posterior fossa. Subfalcial herniation is tolerated unless lateral displacement is excessive.

Type
Review Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 2 , May 1995 , pp. 83 - 91
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

References

1.Cushing, H.Some principles of cerebral surgery. JAMA 1909; 52: 184–195.CrossRefGoogle Scholar
2.Meyer, A.Herniation of the brain. Arch Neurol Psychiatr 1920; 4: 387–400.CrossRefGoogle Scholar
3.Scheinker, IM.Transtentorial herniation of the brain stem; a characteristic clinicopathologic syndrome; pathogenesis of hemorrhages in the brain stem. Arch Neurol Psychiatr 1945; 53: 289–298.CrossRefGoogle Scholar
4.LeBeau, J.L’oedème du Cerveau. Paris, Recht 1938.Google Scholar
5.Fisher, CM.The neurological examination of the comatose patient. Acta Neurol Scand 1969; 45 (Suppl 36): 1–56 p .52.Google ScholarPubMed
6.Fisher, CM.Acute brain herniation - a revised concept. Semin Neurol 1984; 4: 417–421.CrossRefGoogle Scholar
7.Elguera, M.Transtentorial herniation. In: Finney, LA., Walker, AE., eds. Springfield III: Charles C Thomas, 1962.Google Scholar
8.Vincent, C., David, M., Thiébaut, F.Le cône de pression temporal dans les tumeurs cérébrales. Rev Neurol 1936; 65: 536–545.Google Scholar
9.Schwarz, GA., Rosner, A.Displacement and herniation of the hippocampal gyrus through the incisura tentorii: a clinicopathologic study. Arch Neurol Psychiatr 1941; 46: 297–321.CrossRefGoogle Scholar
10.Jefferson, G.The tentorial pressure cone. Arch Neurol Psychiatr 1938; 40: 857–876.CrossRefGoogle Scholar
11.Smyth, GE., Henderson, WR.Observations on the cerebrospinal fluid pressure on simultaneous ventricular and lumbar punctures. J Neurol Psychiatr 1938; 1: 226–238.CrossRefGoogle ScholarPubMed
12.Magoun, HW.An ascending reticular activating system in the brain stem. Arch Neurol Psychiatr 1952; 67: 145–154.CrossRefGoogle ScholarPubMed
13.Azambuja, N., Lindgren, E., Sjogren, SE.Tentorial herniations. Acta Radiol (Stockh) 1956; 46: 215–223, 223–231, 232–239.CrossRefGoogle ScholarPubMed
14.Macpherson, P., Matheson, MS.Comparison of calcification of pineal, habenular commissure and choroid plexus on plain films and computed tomography. Neuroradiology 1979; 18: 67–72.CrossRefGoogle ScholarPubMed
15.Osborn, AG.Diagnosis of descending transtentorial herniation by cranial computed tomography. Radiology 1977; 123: 93–96.CrossRefGoogle ScholarPubMed
16.Storing, J.Descending tentorial herniation: findings on computed tomography. Neuroradiology 1977; 14: 101–105.CrossRefGoogle Scholar
17.Fisher, CM.Observations concerning brain herniation. Ann Neurol 1983; 14: 110 (abst.)Google Scholar
18.Munro, D., Sission, WR jr. Hernia through the incisura of the tentorium cerebelli in connection with craniocerebral trauma. N Engl J Med 1952; 247: 699–708.CrossRefGoogle ScholarPubMed
19.Ropper, AH.Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Engl J Med 1986; 314: 953–958.CrossRefGoogle ScholarPubMed
20.Ross, DA., Olsen, WL., Ross, AM., Andrews, BT., Pitts, LH.Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma. J Neurosurg 1989; 71: 498–502.CrossRefGoogle ScholarPubMed
21.Howell, DA.Longitudinal brain stem compression with buckling: some further observations on a form of upper brain stem compression with intracranial space occupying lesions and brain swelling. Arch Neurol 1961; 4: 572–579.CrossRefGoogle ScholarPubMed
22.Plum, F., Posner, JB.The Diagnosis of Stupor and Coma. 3rd ed. Philadelphia, FADavis 1980.Google Scholar
23.Reich, JB., Sierra, J., Deck, MDF., Plum, F.MRI description and clinical correlation of dynamic upward and downward transtentorial and foramen magnum brain herniation. Ann Neurol 1993; 33: 159–170.CrossRefGoogle Scholar
24.Ropper, AH.Syndrome of transtentorial herniation: is vertical displacement necessary? J Neurol Neurosurg Psychiatry 1993; 56: 932–935.CrossRefGoogle ScholarPubMed
25.Pannullo, SC., Reich, JB., Krol, G., Deck, MDF.Posner, JB.MRI changes in intracranial hypotension. Neurology 1993; 43: 919–926.CrossRefGoogle ScholarPubMed
26.Sunderland, S.The tentorial notch and complications produced by herniations of the brain through that aperture. Br J Surg 1958; 455: 422–438.Google Scholar
27.Hakim, S., Venegas, JG., Burton, JD.The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus. Mechanical interpretation and mathematical model. Surg Neurol 1976; 5: 187–210.Google ScholarPubMed
28.Fisher, CM.The arterial source of secondary brain stem hemorrhages. J Pathol 1972; 66: 9a (abst).Google Scholar
29.Fisher, CM., Ojemann, RG.Bilateral decompressive craniotomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure. Surg Neurol 1994; 41: 65–74.CrossRefGoogle ScholarPubMed