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Kernohan's notch is a cerebral peduncle indentation associated with some forms of transtentorial herniation (uncal herniation). [1] [2] It is a secondary condition caused by a primary injury on the opposite hemisphere of the brain. [3]
Other possibilities resulting from brain stem distortion include lethargy, slow heart rate, and pupil dilation. [9] Uncal herniation may advance to central herniation. [7] The sliding uncus syndrome represents uncal herniation without alteration in the level of consciousness and other sequelae mentioned above.
Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury.It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract. [1]
Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and bradycardia. [1]
Intracranial hypertension (IH), also called increased ICP (IICP) or raised intracranial pressure (RICP), refers to elevated pressure in the cranium. 20–25 mmHg is the upper limit of normal at which treatment is necessary, though it is common to use 15 mmHg as the threshold for beginning treatment.
The treatment of choice for this condition is the surgical application of epidural blood patches, [27] [79] [80] which has a higher success rate than conservative treatments of bed rest and hydration. [81]
This is called herniation and will often cause an enlarged pupil on the affected side, due to pressure on the oculomotor nerve. Tentorial herniation is a serious symptom, especially since the brainstem is likely to be compressed as well if the intracranial pressure rises further. A common type of herniation is uncal herniation.
In children, a sitting flexed position was as successful as lying on the side with respect to obtaining non-traumatic CSF, CSF for culture, and cell count. There was a higher success rate in obtaining CSF in the first attempt in infants younger than 12 months in the sitting flexed position. [30]