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, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Contributor Information and Disclosures

Updated: Mar 16, 2010

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 the above image. 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 the above image. 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 the above 2 images. 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 the above 2 images. 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 the above image. 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 the above image. 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 in the same patient as in the above image. 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 in the same patient as in the above image. 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
Further Reading

References

  1. Probst MA, Baraff LJ, Hoffman JR, Wolfson AB, Ourian AJ, Mower WR. Can patients with brain herniation on cranial computed tomography have a normal neurologic exam?. Acad Emerg Med. Feb 2009;16(2):145-50. [Medline].

  2. Danzer E, Finkel RS, Rintoul NE, Bebbington MW, Schwartz ES, Zarnow DM, et al. Reversal of hindbrain herniation after maternal-fetal surgery for myelomeningocele subsequently impacts on brain stem function. Neuropediatrics. Dec 2008;39(6):359-62. [Medline].

  3. Koenig MA, Bryan M, Lewin JL 3rd, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. Mar 25 2008;70(13):1023-9. [Medline].

  4. Leikola J, Koljonen V, Valanne L, Hukki J. The incidence of Chiari malformation in nonsyndromic, single suture craniosynostosis. Childs Nerv Syst. Dec 16 2009;[Medline].

  5. Aquilina K, Merchant TE, Boop FA, Sanford RA. Chiari I malformation after cranial radiation therapy in childhood: a dynamic process associated with changes in clival growth. Childs Nerv Syst. Nov 2009;25(11):1429-36. [Medline].

  6. Yuh EL, Gean AD, Manley GT, Callen AL, Wintermark M. Computer-aided assessment of head computed tomography (CT) studies in patients with suspected traumatic brain injury. J Neurotrauma. Oct 2008;25(10):1163-72. [Medline].

  7. Jang SH, Kim DS, Son SM, et al. Clinical application of diffusion tensor tractography for elucidation of the causes of motor weakness in patients with traumatic brain injury. NeuroRehabilitation. 2009;24(3):273-8. [Medline].

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  12. Manawadu D, Quateen A, Findlay JM. Hemicraniectomy for massive middle cerebral artery infarction: a review. Can J Neurol Sci. Nov 2008;35(5):544-50. [Medline].

  13. Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:61-2.

  14. Kan P, Amini A, Hansen K, et al. Outcomes after decompressive craniectomy for severe traumatic brain injury in children. J Neurosurg. Nov 2006;105(5 Suppl):337-42. [Medline].

  15. Meadows J, Kraut M, Guarnieri M, et al. Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg. Jun 2000;92(6):920-6. [Medline].

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  17. Procaccio F, Stocchetti N, Citerio G, et al. Guidelines for the treatment of adults with severe head trauma (part I). Initial assessment; evaluation and pre-hospital treatment; current criteria for hospital admission; systemic and cerebral monitoring. J Neurosurg Sci. Mar 2000;44(1):1-10. [Medline].

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Further Reading

Clinical guidelines

Treatment: cerebral herniation. In: Guidelines for the prehospital management of severe traumatic brain injury, second edition.
Brain Trauma Foundation - Disease Specific Society
National Highway Traffic Safety Administration - Federal Government Agency [U.S.]. 2000 (revised 2007). 8 pages. NGC:006388

Guidelines for the management of severe traumatic brain injury. Intracranial pressure thresholds.
Brain Trauma Foundation - Disease Specific Society. 2000 (revised 2007). 4 pages. NGC:005776

Clinical trials

Establishing the Physiology of Syringomyelia

Genetic Analysis of the Chiari I Malformation

The Genetics of Chiari Type I Malformation

Related eMedicine topics

Posterior Fossa Tumors

Head Trauma (Pediatrics: Cardiac Disease and Critical Care Medicine)

Head Trauma (Trauma)

Chiari Malformation

Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology

Keywords

brain herniation, Arnold-Chiari malformation, supratentorial, uncal herniation, brain displacement, mass effect, transtentorial herniation, transtentorial, tonsillar herniation, subfalcine herniation, extracranial 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, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Mahesh R Patel, MD is a member of the following medical societies: American Roentgen Ray Society, American Society of Neuroradiology, and 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, Resolution Imaging Medical Corporation
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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