8/1/2023 0 Comments Trace gallagher blown pupilTonsillar herniation causes the Cushing reflex, consisting of irregular breathing, bradycardia, and hypertension. This results in compression of the brainstem, which contains many important homeostatic centers including centers that regulate breathing and consciousness. Tonsillar herniation is a posterior fossa herniation characterized by herniation of the cerebellar tonsils through the foramen magnum. The significance of decreased level of consciousness should not be ignored in these patients. The earliest reliable sign is the ipsilateral blown pupil. Uncal herniation results in a classic uncal herniation syndrome involving ipsilateral cranial nerve III palsy (fixed, dilated, so-called ‘blown’ pupil), coma, and contralateral hemiparesis. The uncus herniates medially into the tentorial notch, causing compression on the 3rd nerve then brainstem as it progresses. Uncal herniation is the herniation of the uncus, which is a part of the anteromedial portion of the temporal lobe. These are the supratentorial uncal herniation syndrome and the infratentorial tonsillar herniation. There are two classic brain herniation syndromes that should be considered for patients presenting acutely. However spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury (TBI) are common causes of herniation in the acute setting this is frequently related to trauma ± hemorrhage. 1 Any mass lesion, including hemorrhage, tumor, vasogenic or cytotoxic edema, trauma or infection can cause herniation. ![]() Different types of brain herniation can occur depending on the location of mass effect and how rapidly this mass effect develops. Brain herniation is a catastrophic sequela of increased intracranial pressure (ICP) or local mass effect from intracranial lesions.
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