Multimedia
 | 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. |
 | 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. |
 | 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. |
 | 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. |
 | 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. |
 | 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. |
 | 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. |
 | 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. |
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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
