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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.
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.
Types of brain herniation [21] 1) Uncal 2) Central - The brainstem herniates caudally. 3) Cingulate herniation - The brain squeezes under the falx cerebri . 4) Transcalvarial herniation - through a skull fracture 5) Upward herniation of the cerebellum 6) Tonsillar herniation - the cerebellar tonsils herniate through the foramen magnum.
[42] [58] Women are three times more likely than men to have a congenital Chiari malformation. [59] Type II malformations are more prevalent in people of Celtic descent. [58] A study using upright MRI found cerebellar tonsillar ectopia in 23% of adults with headache from motor-vehicle-accident head trauma.
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.
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