A brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or pressed away from their usual position inside the skull.
Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most often the result of brain swelling from a head injury, stroke, or brain tumor.
Brain herniation is the most common side effect of tumors in the brain, including:
Herniation of the brain can also be caused by other factors that lead to increased pressure inside the skull, including:
Brain herniation can occur:
Patients with a brain herniation have:
A brain and nervous system (neurological) exam shows changes in alertness (consciousness). Depending on the severity of the herniation and the part of the brain that is being pressed on, there will be problems with one or more brain-related reflexes and nerve functions.
Brain herniation is a medical emergency. The goal of treatment is to save the patient's life.
To help reverse or prevent a brain herniation, the medical team will treat increased swelling and pressure in the brain. Treatment may involve:
The outlook varies and depends on where in the brain the herniation occurs. Without treatment, death is likely.
A brain herniation often causes a massive stroke. There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death.
Call your local emergency number (such as 911) or take the patient to a hospital emergency room if he or she develops decreased alertness or other symptoms, especially if there has been a head injury or if the person has a brain tumor or blood vessel problem.
Prompt treatment of increased intracranial pressure and related disorders may reduce the risk of brain herniation.
Herniation syndrome; Transtentorial herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain
Ling GSF. Traumatic Brain Injury and Spinal Cord Injury. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 406.
Stippler M. Trauma of the Nervous System: Craniocerebral Trauma. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC,eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa:Saunders Elsevier; 2012:chap 50B.
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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