🧠 Brain Herniation Syndromes — Recognition and Management
Match the localising signs of each brain-herniation type to emergency intracranial-pressure reduction. Instant, browser-side.
Brain Herniation Syndromes — Recognition and Management
Herniation type
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 0.25–1 g/kg IV push or hypertonic saline (3% 250 mL / 23.4% 30 mL via central line), monitoring sodium/osmolality.
- Brief hyperventilation to PaCO₂ 30–35 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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.