A brain herniation is when brain tissue, cerebrospinal fluid, and blood vessels are moved or pressed away from their usual position inside the skull.
Herniation syndrome; Transtentorial herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation – brain
Causes, incidence, and risk factors
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,
Brain herniation is the most common 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:
Strokes that cause brain swelling
Swelling after radiation therapy
Brain herniation can occur:
- Between areas inside the skull, such as those separated by a rigid membrane like the tentorium or falx
- Through a natural opening at the base of the skull called the foramen magnum
Through openings created during brain surgery
- Cardiac arrest (no pulse)
- Loss of all brainstem reflexes (blinking, gagging, pupils reacting to light)
- Loss of consciousness
Respiratory arrest(no breathing)
- Wide (dilated) pupils and no movement in one or both eyes
Signs and tests
Patients with a brain herniation have:
High blood pressure Irregular breathing Irregular pulse
- Slow pulse
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:
- Placing a drain into the brain to help remove cerebrospinal fluid (CSF)
Corticosteroids, such as dexamethasone, especially if there is a brain tumor, to reduce swelling
Medications that remove fluid from the body, such as mannitol or other diuretics, which reduce pressure inside the skull
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
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.
- Brain death
- Permanent and significant neurologic problems
Calling your health care provider
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
Related:Brain injury – discharge , Brain surgery, Brain tumor – children, Metastatic brain tumor, Hydrocephalus