🧠 Brain Herniation Syndromes — Recognition and Management
UseRecognise brain-herniation syndromes and apply emergency ICP-lowering measures.
SourceCarney N, et al. Brain Trauma Foundation Guidelines for the Management of Severe TBI, 4th ed. Neuro…
This-shift next steps
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Methodology · worked example, guidelines & full notes
Osmotherapy: mannitol IV push or hypertonic saline, monitoring sodium/osmolality.
When to use
Recognise brain-herniation syndromes and apply emergency ICP-lowering measures.
How it works
Uncal: ipsilateral fixed dilated pupil + contralateral hemiparesis. Central: rostral-caudal deterioration. Subfalcine: ACA compression, lower-limb weakness. Tonsillar (foramen magnum): Cushing's triad + respiratory arrest. Upward: aqueductal obstruction. General rescue: head-up 30°, osmotherapy, brief hyperventilation as a bridge, emergency neurosurgical decompression.
Key points
- Osmotherapy: mannitol IV push or hypertonic saline, monitoring sodium/osmolality.
- Brief hyperventilation [pending update] is a rescue bridge only — avoid prolonged levels < 30 to prevent rebound ischemia.
- Lumbar puncture is contraindicated in posterior-fossa / obstructive raised pressure (tonsillar herniation).
- Definitive treatment is etiologic: hematoma evacuation, decompressive craniectomy, EVD, plus correction of coagulopathy and control of seizures/fever.
References
- [Guideline / primary source]Carney N, et al. Brain Trauma Foundation Guidelines for the Management of Severe TBI, 4th ed. Neurosurgery 2017
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Herniation type | Subfalcine (cingulate) herniation |
|---|
→HerniationSubfalcine herniation
- Localising signs：Cingulate gyrus displaced under the falx with midline shift; may compress the anterior cerebral artery (ACA) → contralateral predominantly lower-limb weakness; often a precursor to other herniations
- Emergency management (general)：Head-of-bed elevation 30°, head/neck midline to avoid jugular compression; secure airway/oxygenation, avoid hypotension; analgesia-sedation
- Osmotherapy：Mannitol IV push; or hypertonic saline, monitoring serum sodium/osmolality
| Herniation type | Uncal herniation (transtentorial) |
|---|
→HerniationUncal herniation
- Localising signs：Ipsilateral oculomotor nerve (CN III) compression → ipsilateral fixed dilated pupil and ptosis; contralateral hemiparesis (if the contralateral cerebral peduncle is compressed — Kernohan's notch → ipsilateral hemiparesis, a false localising sign); declining consciousness; may progress to decerebrate posturing
- Emergency management (general)：Head-of-bed elevation 30°, head/neck midline to avoid jugular compression; secure airway/oxygenation, avoid hypotension; analgesia-sedation
- Osmotherapy：Mannitol IV push; or hypertonic saline, monitoring serum sodium/osmolality
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Brain Herniation Syndromes — Recognition and Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Brain Herniation Syndromes — Recognition and Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Brain Herniation Syndromes — Recognition and Management calculated in practice? Can you show a worked example?
- Inputs: Herniation type Subfalcine (cingulate) herniation → Result: Herniation Subfalcine herniation（Localising signs: Cingulate gyrus displaced under the falx with midline shift; may compress the anterior cerebral artery (ACA) → contralateral predominantly lower-limb weakness; often a precursor to other herniations, Emergency management (general): Head-of-bed elevation 30°, head/neck midline to avoid jugular compression; secure airway/oxygenation, avoid hypotension; analgesia-sedation, Osmotherapy: Mannitol IV push; or hypertonic saline, monitoring serum sodium/osmolality） Inputs: Herniation type Uncal herniation (transtentorial) → Result: Herniation Uncal herniation（Localising signs: Ipsilateral oculomotor nerve (CN III) compression → ipsilateral fixed dilated pupil and ptosis; contralateral hemiparesis (if the contralateral cerebral peduncle is compressed — Kernohan's notch → ipsilateral hemiparesis, a false localising sign); declining consciousness; may progress to decerebrate posturing, Emergency management (general): Head-of-bed elevation 30°, head/neck midline to avoid jugular compression; secure airway/oxygenation, avoid hypotension; analgesia-sedation, Osmotherapy: Mannitol IV push; or hypertonic saline, monitoring serum sodium/osmolality）