Learn About Brain Herniation

What is the definition of Brain Herniation?

Brain herniation is the shifting of the brain tissue from one space in the brain to another through various folds and openings.

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What are the alternative names for Brain Herniation?

Herniation syndrome; Transtentorial herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain

What are the causes of Brain Herniation?

Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most often the result of brain swelling or bleeding from a head injury, stroke, or brain tumor.

Brain herniation can be a side effect of tumors in the brain, including:

  • Metastatic brain tumor
  • Primary brain tumor

Herniation of the brain can also be caused by other factors that lead to increased pressure inside the skull, including:

  • Collection of pus and other material in the brain, usually from a bacterial or fungal infection (abscess)
  • Bleeding in the brain (hemorrhage)
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Strokes that cause brain swelling
  • Swelling after radiation therapy
  • Defect in brain structure, such as a condition called Arnold-Chiari malformation

Brain herniation can occur:

  • From side to side or down, under, or across rigid membrane like the tentorium or falx
  • Through a natural bony opening at the base of the skull called the foramen magnum
  • Through openings created during brain surgery
What are the symptoms of Brain Herniation?

Signs and symptoms may include:

  • High blood pressure
  • Irregular or slow pulse
  • Severe headache
  • Weakness
  • Cardiac arrest (no pulse)
  • Loss of consciousness, coma
  • Loss of all brainstem reflexes (blinking, gagging, and pupils reacting to light)
  • Respiratory arrest (no breathing)
  • Wide (dilated) pupils and no movement in one or both eyes
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What are the current treatments for Brain Herniation?

Brain herniation is a medical emergency. The goal of treatment is to save the person'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:

  • Placing a drain into the brain to help remove cerebrospinal fluid (CSF)
  • Medicines to reduce swelling, especially if there is a brain tumor
  • Medicines that decrease brain swelling, such as mannitol, saline, or other diuretics
  • Placing a tube in the airway (endotracheal intubation) and increasing the breathing rate to reduce the levels of carbon dioxide (CO2) in the blood
  • Removing blood or blood clots if they are raising pressure inside the skull and causing herniation
  • Removing part of the skull to give the brain more room
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What is the outlook (prognosis) for Brain Herniation?

People who have a brain herniation have a serious brain injury. They may already have a low chance of recovery due to the injury that caused the herniation. When herniation occurs, it further lowers the chance of recovery.

The outlook varies, depending on where in the brain the herniation occurs. Without treatment, death is likely.

There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death.

What are the possible complications of Brain Herniation?

Complications may include:

  • Brain death
  • Permanent and significant neurologic problems
When should I contact a medical professional for Brain Herniation?

Call 911 or the local emergency number or take the person to a hospital emergency room if they develop 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.

How do I prevent Brain Herniation?

Prompt treatment of increased intracranial pressure and related disorders may reduce the risk for brain herniation.

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What are the latest Brain Herniation Clinical Trials?
A Randomised Controlled Trial to Evaluate Decompressive Craniectomy for Patients With Cerebral Herniation Undergoing Evacuation of Acute Epidural Hematoma

Summary: Although craniotomy provides a more complete evacuation of the acute epidural hematoma, there are insufficient data to support specific surgical treatment method. We aim to perform a multi-center, parallel-group randomized clinical trial to compare the outcome and cost-effectiveness of decompressive craniectomy versus craniotomy for the treatment of traumatic brain injury patients with cerebral he...

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Simulation Training in Emergency Department Imaging 2

Summary: Background and study aims: Computerised Tomography (CT) head scans are frequently requested by Emergency Department (ED) clinicians as one of the investigations for their patients. This often causes a delay when waiting for specialist radiologists to report the findings of the scan. The purpose of this study is to see if online training can improve the ability of ED clinicians to interpret the sca...

What are the Latest Advances for Brain Herniation?
Multiorgan Infarctions in a Young Adult with COVID-19: Autopsy Findings.
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Post-traumatic hydrocephalus - incidence, risk factors, treatment, and clinical outcome.
Who are the sources who wrote this article ?

Published Date: August 02, 2020
Published By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Beaumont A. Physiology of the cerebrospinal fluid and intracranial pressure. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 52.

Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.

Stippler M. Craniocerebral trauma. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 62.