Imaging of head trauma
Helen Whitwell, Christopher Milroy, Daniel du Plessis in Forensic Neuropathology, 2021
Brain swelling, intra- and extra-axial haematomas can result in significant brain herniation. The types of herniation are based on direction of the brain shift. Asymmetry between the two sides or effacement of normal CSF planes aid recognition. This topic is discussed in a separate chapter. The syndromes include the following:Subfalcine herniation (Figure 3.33)Descending transtentorial herniation (Figure 3.34)Uncal herniation (Figure 3.34)Tonsillar herniationAscending transtentorial herniationExtracranial herniation
Neoplasms
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Radiotherapy to the nervous system results in initial amplification of symptoms because of secondary local oedema. Drowsiness, headache, nausea and a worsening of pre-existing focal symptoms result.42 Brain herniation is an acute risk. Corticosteroids can minimise these. The beneficial effect may take at least 10 days following the completion of radiotherapy to declare itself. Subacute encephalopathy typically presents 1–6 months following completion of radiotherapy. Headache, somnolence, fatigue and deterioration of pre-existing deficits occur secondary to diffuse demyelination.42 This is spontaneously reversible over several months. Late delayed consequences may appear after 6 months, and these are irreversible and often progressive.42 Damage to white matter causes symptoms ranging from mild lassitude and minor cognitive slowing to a severe dementia. The prevalence of these complications is uncertain, perhaps a few per cent. Changing technology and methods make it difficult to interpret retrospective studies.43 Dose and dose scheduling, concurrent chemotherapy and older age are risk factors for these complications. The risks with focal and stereotactic radiation are negligible.
Head Injury
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
Considerable emphasis is given to the immediate management of head injury, mostly focused on neurosurgical aspects and specifically how to identify patients in need of decompression to prevent brain herniation. Patients with HI have often been managed (for example in the UK) through general surgical admission pathways and only to neurosurgeons if necessary. They may frequently return in an impaired state to general surgical units. Patients may then be discharged to the community or to rehabilitation facilities. There remains a void in HI treatment during and following this acute phase, and this is often not recognized by clinicians because of its predominantly cognitive presentation. Some healthcare providers have filled this void by establishing ‘acute brain injury units’ where further medical management is carried out using an identical principle of care to acute stroke units and filling the gap between the acute situation and early rehabilitation.
Anatomic variations of the human falx cerebelli and its association with occipital venous sinuses
Published in British Journal of Neurosurgery, 2021
Safiye Çavdar, Bilgehan Solmaz, Özgül Taniş, Orhan Ulas Guler, Hakkı Dalçık, Evren Aydoğmuş, Leyla Altunkaya, Erdoğan Kara, Hızır Aslıyüksek
Brain herniation is a highly mortal complication of space-occupying lesions of the brain (intracranial hemorrhages, tumors, hydrocephalus or any lesion leads to brain edema) and it is related to the compensation capacity of the dural reflections of falx and tentorium cerebelli.6 The dimensions and increased number of folds may contribute to the elasticity of falx cerebelli which may affect the compensation capacity. Early intervention may be considered in posterior fossa tumors or hemorrhages in patients with multiple falx cerebelli. Therefore, being aware of the variations related to dural folds and occipital sinus can be important for neurosurgeons and neuroradiologists as these aberrant structures could cause haemorrhage during suboccipital approaches or may lead to erroneous interpretation during imaging of the posterior cranial fossa.
The rare manifestations in tuberculous meningoencephalitis: a review of available literature
Published in Annals of Medicine, 2023
Rong li He, Yun Liu, Quanhui Tan, Lan Wang
Continuously increased brain pressure is prone to brain hernia, mainly tentorial hernia, axial hernia and foramen magnum hernia [1]. In the late stage of the brain nodule, when the arachnoid membrane of the skull base is widely adhered or the tuberculous inflammation directly invades the nerve, cranial nerve paralysis will occur. Tuberculous spinal meningitis and arachnoiditis, formation of intramedullary granuloma or tuberculous fibrous exudate around the spinal cord and nerve root, often lead to paraplegia, dysuria and nerve root pain. Tuberculous vasculitis throughout the course of the disease is prone to large vessel occlusion, leading to cerebral infarction, tuberculous granuloma and tuberculous abscess compressing brain parenchyma, as well as hemiplegia, such as simultaneous aphasia of dominant hemisphere.
Clinical features of Chinese patients in different age groups with spontaneous intracerebral hemorrhage based on multicenter inpatient information
Published in Neurological Research, 2020
Pingping Wang, Yong Sun, Danhui Yi, Yanming Xie, Yumin Luo
This study showed the incidence of complications such as brain hernia, upper gastrointestinal bleeding, epilepsy was higher in younger patients. These complications were reported associated with ICH volume growth and poor outcome [22,23]. Clinically, this population should be dynamically monitored for intracranial pressure, imaging examination, clinical signs and analyzed in a timely manner to provide effective interventions for the reduction in the incidence of hernias and other malignant complications. Pulmonary infection, urinary tract infections, electrolyte metabolism disorders and pressure injury were more common in older patients. Therefore, attention should be paid to the clinical care of the respiratory tract, urinary tract, skin and electrolyte conditions of elderly patients. The application of drugs, such as dehydration drugs and antihypertensive drugs, that easily lead to electrolyte imbalance should be carefully used and dynamically monitored in these patients.
Related Knowledge Centers
- Falx Cerebri
- Foramen Magnum
- Intracranial Pressure
- Skull
- Traumatic Brain Injury
- Spinal Cord
- Brain
- Cerebellar Tentorium
- Mass Effect
- Intracranial Hemorrhage