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.
Fatal cerebral hemorrhage in a patient with thrombotic thrombocytopenic purpura with a normal platelet count during treatment with caplacizumab
Published in Platelets, 2022
Kim Ditzel, Dirk Jan Mons, Rob Fijnheer
After 15 days of plasmapheresis in total and 5 days of caplacizumab, her platelet count recovered to >150 10^9/l (Figure 1). After 2 days of adequate platelet count, the plasmapheresis was stopped and the caplacizumab was planned to continue for a total of 30 days. She was ready to be discharged 12 days after the start of caplacizumab. Unfortunately, the night before planned discharge, she woke up with a left-sided hemiparesis. A CT-scan showed a massive intracerebral hemorrhage with midline shift and signs of brain herniation. There were no signs of underlying cerebrovascular abnormality. Her platelet count at the time was 606 10^9/l and no coagulation abnormalities were shown. She was given 4000 international units of Haemate-P, a vWF/factor VIII concentrate, to counter the iatrogenic decreased activity of vWF. No platelets were given, since her platelet count was normal and there was no platelet dysfunction. The neurologist consulted with a neurosurgeon, but there were no further therapeutic options. All supportive therapy was stopped and she died a few hours later.
Tumefactive demyelination: updated perspectives on diagnosis and management
Published in Expert Review of Neurotherapeutics, 2021
Pedro Sánchez, Fiona Chan, Todd A. Hardy
As in classical MS, TD usually causes a subacute neurological presentation that can include sensory, cerebellar or motor impairment depending on the size and anatomical site of the lesion. Polysymptomatic presentations are not uncommon and cortical involvement can manifest as cognitive dysfunction, epileptic seizures, encephalopathy or cortical syndromes (aphasia, hemianopsia, neglect), which is not seen with typical MS relapses [5]. In the largest cohort of 168 patients with TD, Lucchinetti and colleagues found encephalopathy in 19% of patients, cortical syndromes in up to 17% and seizures in 6% of cases [5]. In more severe cases, patients can be obtunded and at risk of rapid neurological deterioration due to lesional mass effect and impending brain herniation [12,13].
Related Knowledge Centers
- Falx Cerebri
- Foramen Magnum
- Intracranial Pressure
- Skull
- Traumatic Brain Injury
- Spinal Cord
- Brain
- Cerebellar Tentorium
- Mass Effect
- Intracranial Hemorrhage