eMedicine Specialties > Radiology > Brain/Spine

Brain, Herniation: Multimedia

Author: Margaret Loh, MD, Staff Physician, Department of Radiology, Santa Clara Valley Medical Center
Coauthor(s): Mahesh R Patel, MD, Chief of MRI, Department of Radiology, Santa Clara Valley Medical Center
Contributor Information and Disclosures

Updated: Sep 28, 2007

Multimedia

Nonenhanced head computed tomography (CT) scan at...Media file 1: Nonenhanced head computed tomography (CT) scan at the level of the lateral ventricles was obtained in a 78-year-old man who presented with respiratory failure. The image demonstrates a large right frontal and temporal subdural fluid collection with hyperattenuating and hypoattenuating components consistent with an acute on chronic subdural hematoma. Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and enlargement of the contralateral occipital horn are present.
Nonenhanced head computed tomography (CT) scan at...

Nonenhanced head computed tomography (CT) scan at the level of the lateral ventricles was obtained in a 78-year-old man who presented with respiratory failure. The image demonstrates a large right frontal and temporal subdural fluid collection with hyperattenuating and hypoattenuating components consistent with an acute on chronic subdural hematoma. Subfalcine herniation, midline shift, effacement of the ipsilateral lateral ventricle, and enlargement of the contralateral occipital horn are present.

Nonenhanced head computed tomography scan at the ...Media file 2: Nonenhanced head computed tomography scan at the level of the suprasellar cistern in the same patient as in Image 1. A large right frontotemporal subdural hematoma is exerting mass effect on the right frontal and temporal lobes, with resultant effacement of the suprasellar cistern and with right-sided uncal herniation. Mass effect from the subdural hematoma effaces the ipsilateral temporal horn, causing dilatation of the contralateral temporal horn. Subfalcine herniation and narrowing of the contralateral ambient and quadrigeminal plate cisterns are present.
Nonenhanced head computed tomography scan at the ...

Nonenhanced head computed tomography scan at the level of the suprasellar cistern in the same patient as in Image 1. A large right frontotemporal subdural hematoma is exerting mass effect on the right frontal and temporal lobes, with resultant effacement of the suprasellar cistern and with right-sided uncal herniation. Mass effect from the subdural hematoma effaces the ipsilateral temporal horn, causing dilatation of the contralateral temporal horn. Subfalcine herniation and narrowing of the contralateral ambient and quadrigeminal plate cisterns are present.

Nonenhanced head computed tomography (CT) scan ob...Media file 3: Nonenhanced head computed tomography (CT) scan obtained at the level of the inferior pons in the same patient as in Images 1-2. Acute-on-chronic right temporal subdural hematoma exerts mass effect on the right temporal lobe, causing ipsilateral temporal horn, with effacement and dilatation of the contralateral temporal horn. Narrowing of the contralateral ambient and quadrigeminal plate cisterns is present, with ipsilateral widening of the ambient and quadrigeminal cisterns.
Nonenhanced head computed tomography (CT) scan ob...

Nonenhanced head computed tomography (CT) scan obtained at the level of the inferior pons in the same patient as in Images 1-2. Acute-on-chronic right temporal subdural hematoma exerts mass effect on the right temporal lobe, causing ipsilateral temporal horn, with effacement and dilatation of the contralateral temporal horn. Narrowing of the contralateral ambient and quadrigeminal plate cisterns is present, with ipsilateral widening of the ambient and quadrigeminal cisterns.

Right parasagittal gadolinium-enhanced T1-weighte...Media file 4: Right parasagittal gadolinium-enhanced T1-weighted magnetic resonance image in a 9-year-old girl with a history of right cerebellar astrocytoma who presented with headaches and vomiting. Heterogeneously enhancing mass is demonstrated in the right cerebellum, with compression of the adjacent brainstem and fourth ventricle. Ascending transtentorial herniation of the cerebellum is demonstrated through the incisura. Descending tonsillar herniation also is present.
Right parasagittal gadolinium-enhanced T1-weighte...

Right parasagittal gadolinium-enhanced T1-weighted magnetic resonance image in a 9-year-old girl with a history of right cerebellar astrocytoma who presented with headaches and vomiting. Heterogeneously enhancing mass is demonstrated in the right cerebellum, with compression of the adjacent brainstem and fourth ventricle. Ascending transtentorial herniation of the cerebellum is demonstrated through the incisura. Descending tonsillar herniation also is present.

Axial gadolinium-enhanced T1-weighted magnetic re...Media file 5: Axial gadolinium-enhanced T1-weighted magnetic resonance image obtained at the level of the midbrain in the same patient as in Image 4. A heterogeneously enhancing mass is seen in the right medial anterior cerebellum, with mass effect on the right posterior lateral midbrain and fourth ventricle. The image shows enlargement of the temporal horns of both lateral ventricles as a result of obstruction by the cerebellar mass at the level of the fourth ventricle.
Axial gadolinium-enhanced T1-weighted magnetic re...

Axial gadolinium-enhanced T1-weighted magnetic resonance image obtained at the level of the midbrain in the same patient as in Image 4. A heterogeneously enhancing mass is seen in the right medial anterior cerebellum, with mass effect on the right posterior lateral midbrain and fourth ventricle. The image shows enlargement of the temporal horns of both lateral ventricles as a result of obstruction by the cerebellar mass at the level of the fourth ventricle.

Nonenhanced computed tomography (CT) scan of the ...Media file 6: Nonenhanced computed tomography (CT) scan of the brain at the level of the body of the lateral ventricles was obtained in a 37-year-old man who underwent a right frontotemporal decompression craniectomy for a large right frontal hematoma after a skiing accident. A focal hypoattenuating infarct is seen in the right frontal lobe, with an adjacent edematous brain parenchyma herniating through the right frontotemporal craniectomy defect. The patient had communicating hydrocephalus with dilatation of the lateral ventricles.
Nonenhanced computed tomography (CT) scan of the ...

Nonenhanced computed tomography (CT) scan of the brain at the level of the body of the lateral ventricles was obtained in a 37-year-old man who underwent a right frontotemporal decompression craniectomy for a large right frontal hematoma after a skiing accident. A focal hypoattenuating infarct is seen in the right frontal lobe, with an adjacent edematous brain parenchyma herniating through the right frontotemporal craniectomy defect. The patient had communicating hydrocephalus with dilatation of the lateral ventricles.

T1-weighted sagittal magnetic resonance image thr...Media file 7: T1-weighted sagittal magnetic resonance image through the cervical spine in a child with a history of an Arnold-Chiari I malformation. Image shows tonsillar herniation with compression of the central canal at the craniocervical junction and resultant syringohydromyelia in the visualized portion of the cervical spinal cord.
T1-weighted sagittal magnetic resonance image thr...

T1-weighted sagittal magnetic resonance image through the cervical spine in a child with a history of an Arnold-Chiari I malformation. Image shows tonsillar herniation with compression of the central canal at the craniocervical junction and resultant syringohydromyelia in the visualized portion of the cervical spinal cord.

T2-weighted sagittal magnetic resonance image thr...Media file 8: T2-weighted sagittal magnetic resonance image through the cervical spine was obtained on the same patient as in Image 7. The cerebellar tonsils are projecting inferiorly below the level of the opisthion, with compression of the central canal at the craniocervical junction. Hyperintense syringohydromyelia in the visualized portion of the cervical spinal cord is demonstrated.
T2-weighted sagittal magnetic resonance image thr...

T2-weighted sagittal magnetic resonance image through the cervical spine was obtained on the same patient as in Image 7. The cerebellar tonsils are projecting inferiorly below the level of the opisthion, with compression of the central canal at the craniocervical junction. Hyperintense syringohydromyelia in the visualized portion of the cervical spinal cord is demonstrated.

More on Brain, Herniation

Overview: Brain, Herniation
Imaging: Brain, Herniation
Follow-up: Brain, Herniation
Multimedia: Brain, Herniation
References

References

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Further Reading

Keywords

brain displacement, mass effect, transtentorial herniation, subfalcine/cingulate herniation, subfalcial herniation, foramen magnum/tonsillar herniation, sphenoid/alar herniation, extracranial herniation, uncal herniation

Contributor Information and Disclosures

Author

Margaret Loh, MD, Staff Physician, Department of Radiology, Santa Clara Valley Medical Center
Margaret Loh, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Mahesh R Patel, MD, Chief of MRI, Department of Radiology, Santa Clara Valley Medical Center
Mahesh R Patel, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Chi-Shing Zee, MD, Chief of Neuroradiology, Professor, Departments of Radiology and Neurosurgery, University of Southern California School of Medicine
Chi-Shing Zee, MD is a member of the following medical societies: American Society of Neuroradiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Robert L DeLaPaz, MD, Director, Professor, Department of Radiology, Division of Neuroradiology, Columbia University
Robert L DeLaPaz, MD is a member of the following medical societies: American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

L Gill Naul, MD, Professor and Head, Department of Radiology, Texas A&M University College of Medicine; Chair, Department of Radiology, Chief, Section of Magnetic Resonance Imaging, Scott and White Memorial Hospital and Clinic
L Gill Naul, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

 
 
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