Case Report: Frontalis sign for early bedside consideration of impending uncal herniation

Abstract

It is prudent to have early diagnosis and timely management of uncal herniation for better management of neurosurgical patients. There are several clinical and radiological armamentariums that aid in early recognition of the condition. Through this case report, we try to highlight a simple bedside clinical sign that can be a valuable adjunct in early recognition of the impending uncal herniation especially in scenarios wherein it is difficult to assess the pupillary size and reactivity correctly. The improvement in the sign also confirms the resolution of the mass effect in the postoperative period. This is especially helpful for doctors working in the periphery or in resource restrained areas, for a timely referral of the patient to tertiary centre.

Targeted Temperature Management following Traumatic Brain Injury: ESICM / NACCS Consensus Recommendations Guidelines

“…Cerebral herniation is a life-threatening event that requires early diagnosis and prompt management in order to prevent irreversible pathological cascades that can lead to death. 19 Increases in brain temperature have been linked to a linear rise in ICP, with the relationships between temperature, ICP and cerebral perfusion pressure (CPP) becoming more apparent with rapid temperature changes. The impact of temperature on ICP supports the recommendation from the group that temperature control is an essential aspect of care in patients at risk of herniation.…”