Hernia through the Incisura of the Tentorium Cerebelli in Connection with Craniocerebral Trauma

Munro, Donald; Sisson, Warren R.

doi:10.1056/nejm195211062471901

Cited by 42 publications

(10 citation statements)

References 8 publications

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“…shift of septum peflucidum and interpeduncularfossa; b) Shifts of the pineal, interpeduncularfossa and intercollicular sulcus were also logarithmically related to septum shift (see text). 5 6) 8-1 mean (SD) (3-6) 6-3 mean (SD) ( 2 5) 2-9 mean (SD) ( 1 7) 3-1 mean (SD) (1-8) 0 7 mean (SD) (0 9) 7-7 mean (SD) (2 9) 3-8 mean (SD) (1 5) 5-7 mean (SD) (3*4) 5-2 mean (SD) (3)(4)(5) 9-0 mean (SD) (3*3) 5-7 mean SD (2 7) cerebral mass relates closely to depressed consciousness. 12 Although brainstem distortion itself is implicated in the mechanism of depressed consciousness, transtentorial herniation does not consistently correlate with the clinical status of the patient.'…”

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confidence: 99%

Magnetic resonance imaging assessment of brainstem distortion associated with a supratentorial mass.

Inao

Kuchiwaki

Kanaiwa

et al. 1993

Journal of Neurology, Neurosurgery & Psychiatry

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confidence: 99%

Magnetic resonance imaging assessment of brainstem distortion associated with a supratentorial mass.

Inao

Kuchiwaki

Kanaiwa

et al. 1993

Journal of Neurology, Neurosurgery & Psychiatry

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“…The sum of these 2 distances established the height of the brain. In the same plane, we measured (3) the horizontal distance from the center of the lower 3rd ventricle to the midline and (4) the horizontal distance from the intercollicular cistern to the midline. Four patients also had sagittal T,-weighted images with measurement of the vertical distance from the bottom of the SSS to the PMJ, and from Twining's line perpendicularly to the PMJ (Twining-PMJ) similar to a previous study.…”

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confidence: 99%

A preliminary MRI study of the geometry of brain displacement and level of consciousness with acute intracranial masses

Ropper¹

1989

Neurology

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We determined the horizontal and vertical components of brain displacement on coronal MRIs in 10 patients with acute supratentorial masses. The vertical distances from the superior sagittal sinus to the pontomesencephalic junction (PMJ) and from the vertical midline of the brain to the PMJ did not differ from measurements in 30 patients without masses. Horizontal displacement of the 3rd ventricle (mean, 5.2 mm) exceeded vertical displacement of the PMJ (mean, 1.2 mm) in all but 1 patient. Total brain displacement near the incisura increased from 3 mm in awake patients to 6 to 13 mm in stuporous and comatose patients and remained predominantly horizontal. Uncal herniation, seen only in a patient who was imaged a day after the onset of coma, did not appear to be the immediate cause of brainstem compression but was accompanied by prominent lateral distortion above the tentorium. This preliminary study suggests that most patients with acute unilateral masses have upper brainstem distortion due predominantly to horizontal shift at or above the tentorium.

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“…[10][11][12][13] We found, in a large and diverse group of 28,316 ED patients selected to undergo cranial CT, that there were many individuals with abnormal findings, 161 of whom had frank herniation and 91 of whom had significant shift. Only a small proportion of patients with brain herniation (3 ⁄ 161) or significant brain shift (4 ⁄ 91) had a grossly normal neurologic examination.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]5,[7][8][9] It is generally assumed that brain herniation is accompanied by clinically evident neurologic dysfunction. [10][11][12][13] However, some have challenged this assumption and proposed that herniation may not be the cause of patients' neurologic compromise, but rather ''harmless late accompaniments of more lethal intracranial processes,'' i.e., lateral displacement of midline structures and posterior fossa overcrowding. They suggest that patients with herniation, especially subfalcine herniation, may be neurologically intact.…”

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confidence: 99%

Can Patients with Brain Herniation on Cranial Computed Tomography Have a Normal Neurologic Exam?

Probst¹,

Baraff²,

Hoffman³

et al. 2009

Academic Emergency Medicine

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Objectives: Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination.Methods: This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED). Clinical information including neurologic examination was prospectively collected on all patients prior to CT scanning. Using the final cranial CT radiology reports from participating centers, all CT scans were classified into three categories: frank herniation, significant shift without frank herniation, and minimal or no shift, based on predetermined explicit criteria. These reports were concatenated with clinical information to form the final study database.

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Hernia through the Incisura of the Tentorium Cerebelli in Connection with Craniocerebral Trauma

Cited by 42 publications

References 8 publications

Magnetic resonance imaging assessment of brainstem distortion associated with a supratentorial mass.

Magnetic resonance imaging assessment of brainstem distortion associated with a supratentorial mass.

A preliminary MRI study of the geometry of brain displacement and level of consciousness with acute intracranial masses

Can Patients with Brain Herniation on Cranial Computed Tomography Have a Normal Neurologic Exam?

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