Raised intracranial pressure and herniation

Epidemiology and Etiology:

·

Common sites:

·

Gross features:

· Subfalcine herniation

· Cingulate gyrus displaced under the falx cerebri

· Transtentorial (uncinate, mesial temporal) herniation

· Medial temporal lobe compressed against the tentorium cerebella

· Tonsillar herniation

· Displacement of the cerebellar tonsils through the foramen magnum

· Brainstem compression, life threatening

· Durette hemorrhages in brainstem

Histologic features:

·

Immunophenotype:

Marker:

Sensitivity:

Specificity:

Molecular features:

·

Other features:

· Subfalcine herniation:

· May compress branches of anterior cerebral artery

· Transtentorial (uncinate, mesial temporal) herniation

· 3^rd nerve compromise

1. Pupil dilation

2. Ocular movements impaired on same side

· Posterior cerebral artery compression

1. Primary visual cortex ischemia

· Contralateral cerebral penduncle (Kernohan’s notch)

1. Hemiparesis ipsilateral

· Hemorrhagic lesions in midbrain and pons

· Tonsillar herniation

· Brainstem compression, life threatening

· Durette hemorrhages in brainstem

References:

· Kumar V, Fausto N, Abbas A. Robbins & Cotran Pathologic Basis of Disease, Seventh Edition. 7th ed. Saunders; 2004:1552.