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data-event-name="pinnable-header.vector-toc.pin">move to sidebar</button> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-unpin-button" data-event-name="pinnable-header.vector-toc.unpin">hide</button> </div> <ul class="vector-toc-contents" id="mw-panel-toc-list"> <li id="toc-mw-content-text" class="vector-toc-list-item vector-toc-level-1"> <a href="#" class="vector-toc-link"> <div class="vector-toc-text">(Top)</div> </a> </li> <li id="toc-Signs_and_symptoms" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Signs_and_symptoms"> <div class="vector-toc-text"> <span class="vector-toc-numb">1</span> <span>Signs and symptoms</span> </div> </a> <ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Causes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Causes</span> </div> </a> <ul id="toc-Causes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Classification" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Classification"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Classification</span> </div> </a> <button aria-controls="toc-Classification-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Classification subsection</span> </button> <ul id="toc-Classification-sublist" class="vector-toc-list"> <li id="toc-Uncal_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Uncal_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Uncal herniation</span> </div> </a> <ul id="toc-Uncal_herniation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Central_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Central_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Central herniation</span> </div> </a> <ul id="toc-Central_herniation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cingulate_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cingulate_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Cingulate herniation</span> </div> </a> <ul id="toc-Cingulate_herniation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transcalvarial_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transcalvarial_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Transcalvarial herniation</span> </div> </a> <ul id="toc-Transcalvarial_herniation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Upward_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Upward_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.5</span> <span>Upward herniation</span> </div> </a> <ul id="toc-Upward_herniation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Tonsillar_herniation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Tonsillar_herniation"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.6</span> <span>Tonsillar herniation</span> </div> </a> <ul id="toc-Tonsillar_herniation-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>External links</span> </div> </a> <ul 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href="https://ca.wikipedia.org/wiki/H%C3%A8rnia_cerebral" title="Hèrnia cerebral – Catalan" lang="ca" hreflang="ca" data-title="Hèrnia cerebral" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Hirneinklemmung" title="Hirneinklemmung – German" lang="de" hreflang="de" data-title="Hirneinklemmung" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Hernia_cerebral" title="Hernia cerebral – Spanish" lang="es" hreflang="es" data-title="Hernia cerebral" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%81%D8%AA%D9%82_%D9%85%D8%BA%D8%B2%DB%8C" title="فتق مغزی – Persian" lang="fa" hreflang="fa" data-title="فتق مغزی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Engagement_c%C3%A9r%C3%A9bral" title="Engagement cérébral – French" lang="fr" hreflang="fr" data-title="Engagement cérébral" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%87%8C%ED%83%88%EC%B6%9C" title="뇌탈출 – Korean" lang="ko" hreflang="ko" data-title="뇌탈출" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Ernia_cerebrale" title="Ernia cerebrale – Italian" lang="it" hreflang="it" data-title="Ernia cerebrale" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Kupenyeza_kwa_ubongo" title="Kupenyeza kwa ubongo – Swahili" lang="sw" hreflang="sw" data-title="Kupenyeza kwa ubongo" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target"><span>Kiswahili</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E8%84%B3%E3%83%98%E3%83%AB%E3%83%8B%E3%82%A2" title="脳ヘルニア – Japanese" lang="ja" hreflang="ja" data-title="脳ヘルニア" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Wg%C5%82obienie_m%C3%B3zgu" title="Wgłobienie mózgu – Polish" lang="pl" hreflang="pl" data-title="Wgłobienie mózgu" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/H%C3%A9rnia_cerebral" title="Hérnia cerebral – Portuguese" lang="pt" hreflang="pt" data-title="Hérnia cerebral" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D0%BB%D0%BE%D0%BA%D0%B0%D1%86%D0%B8%D1%8F_%D0%BC%D0%BE%D0%B7%D0%B3%D0%B0" title="Дислокация мозга – Russian" lang="ru" hreflang="ru" data-title="Дислокация мозга" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Hj%C3%A4rnkompression" title="Hjärnkompression – Swedish" lang="sv" hreflang="sv" data-title="Hjärnkompression" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B9%80%E0%B8%A5%E0%B8%B7%E0%B9%88%E0%B8%AD%E0%B8%99%E0%B8%9C%E0%B8%B4%E0%B8%94%E0%B8%9B%E0%B8%A3%E0%B8%81%E0%B8%95%E0%B8%B4%E0%B8%82%E0%B8%AD%E0%B8%87%E0%B8%AA%E0%B8%A1%E0%B8%AD%E0%B8%87" title="การเลื่อนผิดปรกติของสมอง – Thai" lang="th" hreflang="th" data-title="การเลื่อนผิดปรกติของสมอง" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Beyin_herniasyonu" title="Beyin herniasyonu – Turkish" lang="tr" hreflang="tr" data-title="Beyin herniasyonu" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D0%BB%D0%BE%D0%BA%D0%B0%D1%86%D1%96%D1%8F_%D0%BC%D0%BE%D0%B7%D0%BA%D1%83" title="Дислокація мозку – Ukrainian" lang="uk" hreflang="uk" data-title="Дислокація мозку" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E8%85%A6%E7%96%9D" title="腦疝 – Chinese" lang="zh" hreflang="zh" data-title="腦疝" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div 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id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Potentially deadly side effect of very high pressure within the skull</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Cerebral herniation</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Brain_herniation_MRI.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Brain_herniation_MRI.jpg/220px-Brain_herniation_MRI.jpg" decoding="async" width="220" height="251" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5c/Brain_herniation_MRI.jpg/330px-Brain_herniation_MRI.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/5/5c/Brain_herniation_MRI.jpg 2x" data-file-width="396" data-file-height="452" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">MRI showing injury due to brain herniation</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Neurology" title="Neurology">Neurology</a>, <a href="/wiki/Neurosurgery" title="Neurosurgery">neurosurgery</a> <span class="penicon autoconfirmed-show"><span class="mw-valign-text-top" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q1297985?uselang=en#P1995" title="Edit this on Wikidata"><img alt="Edit this on Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></td></tr></tbody></table> <p><b>Brain herniation</b> is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the <a href="/wiki/Human_brain" title="Human brain">brain</a> is squeezed across structures within the <a href="/wiki/Human_skull" class="mw-redirect" title="Human skull">skull</a>. The brain can shift across such structures as the <a href="/wiki/Falx_cerebri" title="Falx cerebri">falx cerebri</a>, the <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">tentorium cerebelli</a>, and even through the <a href="/wiki/Foramen_magnum" title="Foramen magnum">foramen magnum</a> (the hole in the base of the skull through which the <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a> connects with the brain). Herniation can be caused by a number of factors that cause a <a href="/wiki/Mass_effect_(medicine)" title="Mass effect (medicine)">mass effect</a> and increase <a href="/wiki/Intracranial_pressure" title="Intracranial pressure">intracranial pressure</a> (ICP): these include <a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a>, <a href="/wiki/Intracranial_hemorrhage" title="Intracranial hemorrhage">intracranial hemorrhage</a>, or <a href="/wiki/Brain_tumor" title="Brain tumor">brain tumor</a>.<sup id="cite_ref-Barr07_1-0" class="reference"><a href="#cite_note-Barr07-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Herniation can also occur in the absence of high ICP when <a href="/wiki/Mass_lesion" class="mw-redirect" title="Mass lesion">mass lesions</a> such as <a href="/wiki/Hematoma" title="Hematoma">hematomas</a> occur at the borders of brain compartments. In such cases local pressure is increased at the place where the herniation occurs, but this pressure is not transmitted to the rest of the brain, and therefore does not register as an increase in ICP.<sup id="cite_ref-Gruen02_2-0" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Because herniation puts extreme pressure on parts of the brain and thereby cuts off the blood supply to various parts of the brain, it is often fatal. Therefore, extreme measures are taken in hospital settings to prevent the condition by reducing intracranial pressure, or decompressing (draining) a hematoma which is putting local pressure on a part of the brain. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Decorticate.PNG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2a/Decorticate.PNG/450px-Decorticate.PNG" decoding="async" width="450" height="107" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/2/2a/Decorticate.PNG 1.5x" data-file-width="574" data-file-height="136" /></a><figcaption><a href="/wiki/Decorticate_posturing" class="mw-redirect" title="Decorticate posturing">Decorticate posturing</a>, with elbows, wrists and fingers flexed, and legs extended and rotated inward</figcaption></figure> <p>Brain herniation frequently presents with <a href="/wiki/Abnormal_posturing" title="Abnormal posturing">abnormal posturing</a>,<sup id="cite_ref-Gruen02_2-1" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> a characteristic positioning of the limbs indicative of severe brain damage. These patients have a lowered <a href="/wiki/Altered_level_of_consciousness" title="Altered level of consciousness">level of consciousness</a>, with <a href="/wiki/Glasgow_Coma_Score" class="mw-redirect" title="Glasgow Coma Score">Glasgow Coma Scores</a> of three to five. <a href="/wiki/Coma" title="Coma">Coma</a> and <a href="/wiki/Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">persistent vegetative state</a> also occurs.<sup id="cite_ref-Gruen02_2-2" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> One or both <a href="/wiki/Pupil" title="Pupil">pupils</a> may be <a href="/wiki/Mydriasis" title="Mydriasis">dilated</a> and fail to <a href="/wiki/Pupillary_response" title="Pupillary response">constrict</a> <a href="/wiki/Pupillary_light_reflex" title="Pupillary light reflex">in response to light</a>.<sup id="cite_ref-Gruen02_2-3" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Vomiting can also occur due to compression of the <a href="/wiki/Vomiting_center" class="mw-redirect" title="Vomiting center">vomiting center</a> in the <a href="/wiki/Medulla_oblongata" title="Medulla oblongata">medulla oblongata</a>. Severe <a href="/wiki/Headaches" class="mw-redirect" title="Headaches">headaches</a> and <a href="/wiki/Seizures" class="mw-redirect" title="Seizures">seizures</a> as a result of increased intracranial pressure are not uncommon. <a href="/wiki/Cardiovascular" class="mw-redirect" title="Cardiovascular">Cardiovascular</a> and pulmonary symptoms may also be present as the brain loses function, but might also be associated with <a href="/wiki/Bleeding" title="Bleeding">bleeding</a>. These symptoms are known as <a href="/wiki/Cushing_reflex" title="Cushing reflex">Cushing's Triad</a>: <a href="/wiki/Hypertension" title="Hypertension">hypertension</a> (with widening <a href="/wiki/Pulse_pressure" title="Pulse pressure">pulse pressure</a>), irregular respirations (commonly <a href="/wiki/Cheyne%E2%80%93Stokes_respiration" title="Cheyne–Stokes respiration">Cheyne-Stokes</a>), <a href="/wiki/Bradycardia" title="Bradycardia">bradycardia</a> and in severe cases <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=2" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Causes of brain herniation include:<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Brain_edema" class="mw-redirect" title="Brain edema">Brain edema</a></li> <li><a href="/wiki/Hematoma" title="Hematoma">Hematoma</a></li> <li><a href="/wiki/Stroke" title="Stroke">Stroke</a></li> <li><a href="/wiki/Brain_tumor" title="Brain tumor">Tumour</a></li> <li><a href="/wiki/List_of_infections_of_the_central_nervous_system" title="List of infections of the central nervous system">Infection</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Classification">Classification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=3" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Brain_herniation_types-2.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/79/Brain_herniation_types-2.svg/250px-Brain_herniation_types-2.svg.png" decoding="async" width="250" height="276" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/79/Brain_herniation_types-2.svg/375px-Brain_herniation_types-2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/79/Brain_herniation_types-2.svg/500px-Brain_herniation_types-2.svg.png 2x" data-file-width="619" data-file-height="684" /></a><figcaption>Types of brain herniation.<sup id="cite_ref-isbn1-4051-2627-2_6-0" class="reference"><a href="#cite_note-isbn1-4051-2627-2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>The <a href="/wiki/Cerebellar_tentorium" title="Cerebellar tentorium">tentorium</a> is an extension of the dura mater that separates the <a href="/wiki/Cerebellum" title="Cerebellum">cerebellum</a> from the <a href="/wiki/Cerebrum" title="Cerebrum">cerebrum</a>. There are two major classes of herniation: supratentorial and infratentorial. Supratentorial refers to herniation of structures normally found above the <a href="/wiki/Tentorial_notch" title="Tentorial notch">tentorial notch</a>, and infratentorial refers to structures normally found below it.<sup id="cite_ref-Orlando_Regional_7-0" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <ul><li><b>Supratentorial herniation</b></li></ul> <p>1) <a href="/wiki/Uncus" title="Uncus">Uncal</a> (transtentorial) </p><p>2) Central </p><p>3) <a href="/wiki/Cingulate_gyrus" class="mw-redirect" title="Cingulate gyrus">Cingulate</a> (<a href="/wiki/Falx_cerebri#Subfalcine_brain_herniation" title="Falx cerebri">subfalcine</a> or transfalcine) </p><p>4) <a href="/wiki/Calvarium" class="mw-redirect" title="Calvarium">Transcalvarial</a> </p><p>5) <a href="/wiki/Tectal" class="mw-redirect" title="Tectal">Tectal</a> (posterior) </p> <ul><li><b>Infratentorial herniation</b></li></ul> <p>6) Upward (upward cerebellar or <u>upward</u> transtentorial) </p><p>7) <a href="/wiki/Cerebellar_tonsil" title="Cerebellar tonsil">Tonsillar</a> (downward cerebellar) </p> <div class="mw-heading mw-heading3"><h3 id="Uncal_herniation">Uncal herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=4" title="Edit section: Uncal herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In uncal herniation, a common subtype of transtentorial herniation, the innermost part of the <a href="/wiki/Temporal_lobe" title="Temporal lobe">temporal lobe</a>, the <a href="/wiki/Uncus" title="Uncus">uncus</a>, can be squeezed so much that it moves towards the <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">tentorium</a> and puts pressure on the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a>, most notably the midbrain.<sup id="cite_ref-Shepherd_8-0" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The tentorium is a structure within the <a href="/wiki/Human_skull" class="mw-redirect" title="Human skull">skull</a> formed by the dura mater of the meninges. Tissue may be stripped from the <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a> in a process called <a href="/wiki/Decortication" title="Decortication">decortication</a>.<sup id="cite_ref-McCaffrey_9-0" class="reference"><a href="#cite_note-McCaffrey-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>The uncus can squeeze the <a href="/wiki/Oculomotor_nerve" title="Oculomotor nerve">oculomotor nerve</a> (a.k.a. CN III), which may affect the <a href="/wiki/Parasympathetic" class="mw-redirect" title="Parasympathetic">parasympathetic</a> input to the <a href="/wiki/Human_eye" title="Human eye">eye</a> on the side of the affected nerve, causing the <a href="/wiki/Pupil_(eye)" class="mw-redirect" title="Pupil (eye)">pupil</a> of the affected eye to <a href="/wiki/Pupillary_dilation" class="mw-redirect" title="Pupillary dilation">dilate</a> and fail to constrict in response to light as it should. Pupillary dilation often precedes the somatic motor effects of CN III compression called <a href="/wiki/Oculomotor_nerve_palsy" title="Oculomotor nerve palsy">oculomotor nerve palsy</a> or third nerve palsy. This palsy presents as deviation of the eye to a "down and out" position due to loss of innervation to all <a href="/wiki/Ocular_muscles" class="mw-redirect" title="Ocular muscles">ocular motility muscles</a> except for the <a href="/wiki/Lateral_rectus_muscle" title="Lateral rectus muscle">lateral rectus</a> (innervated by <a href="/wiki/Abducens_nerve" title="Abducens nerve">abducens nerve</a> (a.k.a. CN VI) and the <a href="/wiki/Superior_oblique_muscle" title="Superior oblique muscle">superior oblique</a> (innervated by <a href="/wiki/Trochlear_nerve" title="Trochlear nerve">trochlear nerve</a> a.k.a. CN IV). The symptoms occur in this order because the parasympathetic fibers surround the motor fibers of CN III and are hence compressed first.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2012)">citation needed</span></a></i>]</sup> </p><p>Compression of the ipsilateral <a href="/wiki/Posterior_cerebral_artery" title="Posterior cerebral artery">posterior cerebral artery</a> will result in ischemia of the ipsilateral primary visual cortex and contralateral visual field deficits in both eyes (contralateral <a href="/wiki/Homonymous_hemianopsia" title="Homonymous hemianopsia">homonymous hemianopsia</a>). </p><p>Another important finding is a <i>false localizing sign</i>, the so-called <a href="/wiki/Kernohan%27s_notch" title="Kernohan's notch">Kernohan's notch</a>, which results from compression of the contralateral<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cerebral_crus" title="Cerebral crus">cerebral crus</a> containing descending <a href="/wiki/Corticospinal_tract" title="Corticospinal tract">corticospinal</a> and some <a href="/wiki/Corticobulbar_tract" title="Corticobulbar tract">corticobulbar</a> tract fibers. This leads to Ipsilateral <a href="/wiki/Hemiparesis" title="Hemiparesis">hemiparesis</a> in reference to the herniation and contralateral hemiparesis with reference to the cerebral crus.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2022)">citation needed</span></a></i>]</sup> </p><p>With increasing pressure and progression of the hernia there will be distortion of the brainstem leading to <a href="/wiki/Duret_hemorrhage" class="mw-redirect" title="Duret hemorrhage">Duret hemorrhages</a> (tearing of small vessels in the <a href="/wiki/Parenchyma" title="Parenchyma">parenchyma</a>) in the median and paramedian zones of the <a href="/wiki/Mesencephalon" class="mw-redirect" title="Mesencephalon">mesencephalon</a> and <a href="/wiki/Pons" title="Pons">pons</a>. The rupture of these vessels leads to linear or flamed shaped hemorrhages. The disrupted brainstem can lead to <a href="/wiki/Decorticate_posture" class="mw-redirect" title="Decorticate posture">decorticate posture</a>, respiratory center depression and death. Other possibilities resulting from brain stem distortion include <a href="/wiki/Lethargy" title="Lethargy">lethargy</a>, slow heart rate, and <a href="/wiki/Mydriasis" title="Mydriasis">pupil dilation</a>.<sup id="cite_ref-McCaffrey_9-1" class="reference"><a href="#cite_note-McCaffrey-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Uncal herniation may advance to central herniation.<sup id="cite_ref-Orlando_Regional_7-1" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The <b>sliding uncus syndrome</b> represents uncal herniation without alteration in the level of consciousness and other sequelae mentioned above. </p> <div class="mw-heading mw-heading3"><h3 id="Central_herniation">Central herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=5" title="Edit section: Central herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <i>central herniation</i>, the <a href="/wiki/Diencephalon" title="Diencephalon">diencephalon</a> and parts of the <a href="/wiki/Temporal_lobes" class="mw-redirect" title="Temporal lobes">temporal lobes</a> of both of the <a href="/wiki/Cerebral_hemisphere" title="Cerebral hemisphere">cerebral hemispheres</a> are squeezed through a notch in the <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">tentorium cerebelli</a>.<sup id="cite_ref-Shepherd_8-1" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Cornell_11-0" class="reference"><a href="#cite_note-Cornell-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Transtentorial herniation can occur when the brain moves either up or down across the tentorium, called ascending and descending transtentorial herniation respectively; however descending herniation is much more common.<sup id="cite_ref-Barr07_1-1" class="reference"><a href="#cite_note-Barr07-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Downward herniation can stretch branches of the <a href="/wiki/Basilar_artery" title="Basilar artery">basilar artery</a> (pontine arteries), causing them to tear and bleed, known as a <a href="/wiki/Duret_hemorrhage" class="mw-redirect" title="Duret hemorrhage">Duret hemorrhage</a>. The result is usually fatal.<sup id="cite_ref-Cornell_11-1" class="reference"><a href="#cite_note-Cornell-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Other symptoms of this type of herniation include small, fixed pupils with<sup id="cite_ref-Toronto_Notes_12-0" class="reference"><a href="#cite_note-Toronto_Notes-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> paralysis of upward eye movement giving the characteristic appearance of "sunset eyes". Also found in these patients, often as a terminal complication is the development of <a href="/wiki/Diabetes_insipidus" title="Diabetes insipidus">diabetes insipidus</a> due to the compression of the pituitary stalk. Radiographically, downward herniation is characterized by obliteration of the <a href="/wiki/Chiasmatic_cistern" title="Chiasmatic cistern">suprasellar cistern</a> from temporal lobe herniation into the tentorial hiatus with associated compression on the cerebral peduncles. Upwards herniation, on the other hand, can be radiographically characterized by obliteration of the quadrigeminal cistern. Intracranial hypotension syndrome has been known to mimic downwards transtentorial herniation. </p> <div class="mw-heading mw-heading3"><h3 id="Cingulate_herniation">Cingulate herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=6" title="Edit section: Cingulate herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Subfalcine-herniation-001.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Subfalcine-herniation-001.jpg/220px-Subfalcine-herniation-001.jpg" decoding="async" width="220" height="217" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Subfalcine-herniation-001.jpg/330px-Subfalcine-herniation-001.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Subfalcine-herniation-001.jpg/440px-Subfalcine-herniation-001.jpg 2x" data-file-width="476" data-file-height="469" /></a><figcaption>Subfalcine herniation on CT</figcaption></figure> <p>In <i>cingulate</i> or <i>subfalcine herniation</i>, the most common type, the innermost part of the <a href="/wiki/Frontal_lobe" title="Frontal lobe">frontal lobe</a> is scraped under part of the <a href="/wiki/Falx_cerebri" title="Falx cerebri">falx cerebri</a>, the dura mater at the top of the head between the two <a href="/wiki/Brain_hemisphere" class="mw-redirect" title="Brain hemisphere">hemispheres of the brain</a>.<sup id="cite_ref-Shepherd_8-2" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-dawodu_13-0" class="reference"><a href="#cite_note-dawodu-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Cingulate herniation can be caused when one hemisphere swells and pushes the <a href="/wiki/Cingulate_gyrus" class="mw-redirect" title="Cingulate gyrus">cingulate gyrus</a> by the falx cerebri.<sup id="cite_ref-Orlando_Regional_7-2" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> This does not put as much pressure on the brainstem as the other types of herniation, but it may interfere with <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessels</a> in the frontal lobes that are close to the site of injury (anterior cerebral artery), or it may progress to central herniation.<sup id="cite_ref-Shepherd_8-3" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Interference with the blood supply can cause dangerous increases in ICP that can lead to more dangerous forms of herniation.<sup id="cite_ref-hudson_14-0" class="reference"><a href="#cite_note-hudson-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Symptoms for cingulate herniation are not well defined.<sup id="cite_ref-hudson_14-1" class="reference"><a href="#cite_note-hudson-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Usually occurring in addition to uncal herniation, cingulate herniation may present with <a href="/wiki/Abnormal_posturing" title="Abnormal posturing">abnormal posturing</a> and <a href="/wiki/Coma" title="Coma">coma</a>.<sup id="cite_ref-Orlando_Regional_7-3" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Cingulate herniation is frequently believed to be a precursor to other types of herniation.<sup id="cite_ref-hudson_14-2" class="reference"><a href="#cite_note-hudson-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transcalvarial_herniation">Transcalvarial herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=7" title="Edit section: Transcalvarial herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <i>transcalvarial herniation</i>, the brain squeezes through a fracture or a surgical site in the skull.<sup id="cite_ref-Orlando_Regional_7-4" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Also called "external herniation", this type of herniation may occur during <a href="/wiki/Craniectomy" class="mw-redirect" title="Craniectomy">craniectomy</a>, surgery in which a flap of skull is removed, the protruding brain region preventing the piece of skull from being replaced during the operation.<sup id="cite_ref-Barr07_1-2" class="reference"><a href="#cite_note-Barr07-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Upward_herniation">Upward herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=8" title="Edit section: Upward herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Increased pressure in the posterior <a href="/wiki/Posterior_cranial_fossa" title="Posterior cranial fossa">fossa</a> can cause the <a href="/wiki/Cerebellum" title="Cerebellum">cerebellum</a> to move up through the tentorial opening in <i>upward</i>, or <i>cerebellar herniation</i>.<sup id="cite_ref-Shepherd_8-4" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Midbrain" title="Midbrain">midbrain</a> is pushed through the tentorial notch upward. This is also known as ascending transtentorial herniation since it occurs across the tentorium cerebelli. </p> <div class="mw-heading mw-heading3"><h3 id="Tonsillar_herniation"><span class="anchor" id="coning"></span>Tonsillar herniation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=9" title="Edit section: Tonsillar herniation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <i>tonsillar herniation</i>, also called <i>downward cerebellar herniation</i>,<sup id="cite_ref-Orlando_Regional_7-5" class="reference"><a href="#cite_note-Orlando_Regional-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> transforaminal herniation, or "coning", the cerebellar tonsils move downward through the <a href="/wiki/Foramen_magnum" title="Foramen magnum">foramen magnum</a> possibly causing compression of the lower brainstem and upper cervical spinal cord as they pass through the foramen magnum.<sup id="cite_ref-Shepherd_8-5" class="reference"><a href="#cite_note-Shepherd-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Increased pressure on the brainstem can result in dysfunction of the centers in the brain responsible for controlling respiratory and cardiac function. The most common signs are intractable headache, head tilt, and neck stiffness due to tonsillar impaction. The level of consciousness may decrease and also give rise to flaccid paralysis. Blood pressure instability is also evident in these patients.<sup id="cite_ref-Toronto_Notes_12-1" class="reference"><a href="#cite_note-Toronto_Notes-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>Congenital tonsillar herniation of the <a href="/wiki/Cerebellum" title="Cerebellum">cerebellum</a> is also known as a <a href="/wiki/Chiari_malformation" title="Chiari malformation">Chiari malformation</a> (CM), or previously an Arnold-Chiari malformation (ACM). There are four types of Chiari malformation, and they represent very different disease processes with different symptoms and prognosis. These conditions can be found in asymptomatic patients as an incidental finding, or can be so severe as to be life-threatening. This condition is now being diagnosed more frequently by radiologists, as more patients undergo MRI scans of their heads, especially upright MRI, which is more than twice as sensitive for detecting this condition.<sup id="cite_ref-Upright_MRI_study_15-0" class="reference"><a href="#cite_note-Upright_MRI_study-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Cerebellar tonsillar ectopia (CTE) is a term used by radiologists to describe cerebellar tonsils that are "low lying" but that do not meet the radiographic criteria for definition as a Chiari malformation. The currently accepted radiographic definition for a Chiari malformation is that cerebellar tonsils lie at least 5mm below the level of the foramen magnum. Some clinicians have reported that some patients appear to experience symptoms consistent with a Chiari malformation without radiographic evidence of tonsillar herniation. Sometimes these patients are described as having a 'Chiari [type] 0'. </p><p>There are many suspected causes of tonsillar herniation including: decreased or malformed posterior fossa (the lower, back part of the skull) not providing enough room for the cerebellum; hydrocephalus or abnormal CSF volume pushing the tonsils out; or dural tension pulling the brain caudally. Connective tissue disorders, such as <a href="/wiki/Ehlers_Danlos_syndrome" class="mw-redirect" title="Ehlers Danlos syndrome">Ehlers Danlos syndrome</a>, can be associated. </p><p>For further evaluation of tonsillar herniation, CINE flow studies are used. This type of MRI examines flow of CSF at the cranio-cervical joint. For persons experiencing symptoms but without clear MRI evidence, especially if the symptoms are better in the supine position and worse upon standing/upright, an upright MRI may be useful.<sup id="cite_ref-Gruen02_2-4" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=10" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Brain_injury_with_herniation_MRI.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Brain_injury_with_herniation_MRI.jpg/220px-Brain_injury_with_herniation_MRI.jpg" decoding="async" width="220" height="229" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Brain_injury_with_herniation_MRI.jpg/330px-Brain_injury_with_herniation_MRI.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/59/Brain_injury_with_herniation_MRI.jpg/440px-Brain_injury_with_herniation_MRI.jpg 2x" data-file-width="640" data-file-height="666" /></a><figcaption>MRI showing damage due to herniation. This patient was left with residual disabilities including those involving movement and speech.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Treatment involves removal of the etiologic mass and <a href="/wiki/Decompressive_craniectomy" title="Decompressive craniectomy">decompressive craniectomy</a>. Brain herniation can cause severe disability or death. In fact, when herniation is visible on a <a href="/wiki/CT_scan" title="CT scan">CT scan</a>, the prognosis for a meaningful recovery of neurological function is poor.<sup id="cite_ref-Gruen02_2-5" class="reference"><a href="#cite_note-Gruen02-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The patient may become paralyzed on the same side as the lesion causing the pressure, or damage to parts of the brain caused by herniation may cause paralysis on the side opposite the lesion.<sup id="cite_ref-Cornell_11-2" class="reference"><a href="#cite_note-Cornell-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Damage to the <a href="/wiki/Midbrain" title="Midbrain">midbrain</a>, which contains the <a href="/wiki/Reticular_activating_network" class="mw-redirect" title="Reticular activating network">reticular activating network</a> which regulates <a href="/wiki/Consciousness" title="Consciousness">consciousness</a>, will result in <a href="/wiki/Coma" title="Coma">coma</a>.<sup id="cite_ref-Cornell_11-3" class="reference"><a href="#cite_note-Cornell-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Damage to the cardio-respiratory centers in the <a href="/wiki/Medulla_oblongata" title="Medulla oblongata">medulla oblongata</a> will cause <a href="/wiki/Respiratory_arrest" title="Respiratory arrest">respiratory arrest</a> and (secondarily) <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>.<sup id="cite_ref-Cornell_11-4" class="reference"><a href="#cite_note-Cornell-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Investigation is underway regarding the use of neuroprotective agents during the prolonged post-traumatic period of brain hypersensitivity associated with the syndrome.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p> <div style="clear:both;" class=""></div> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=11" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Second-impact_syndrome" title="Second-impact syndrome">Second-impact syndrome</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Barr07-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Barr07_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Barr07_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Barr07_1-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBarrGeanLe2007" class="citation book cs1">Barr RM, Gean AD, Le TH (2007). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=Sossht2t5XwC&q=extra-axial+intra-axial&pg=PA53">"Craniofacial trauma"</a>. 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class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Brain_herniation&action=edit&section=13" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output 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style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1297985" class="extiw" title="d:Q1297985">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/G93.5">G93.5</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=348.4">348.4</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001421.htm">001421</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/radio/98-overview">radio/98</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_nervous_system,_primarily_CNS" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Central_nervous_system_disease" title="Template:Central nervous system disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Central_nervous_system_disease" title="Template talk:Central nervous system disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Central_nervous_system_disease" title="Special:EditPage/Template:Central nervous system disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_nervous_system,_primarily_CNS" style="font-size:114%;margin:0 4em">Diseases of the <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a>, primarily <a href="/wiki/Central_nervous_system_disease" title="Central nervous system disease">CNS</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Brain" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalitis" title="Encephalitis">Encephalitis</a> <ul><li><a href="/wiki/Viral_encephalitis" title="Viral encephalitis">Viral encephalitis</a></li> <li><a href="/wiki/Herpesviral_encephalitis" class="mw-redirect" title="Herpesviral encephalitis">Herpesviral encephalitis</a></li> <li><a href="/wiki/Limbic_encephalitis" title="Limbic encephalitis">Limbic encephalitis</a></li> <li><a href="/wiki/Encephalitis_lethargica" title="Encephalitis lethargica">Encephalitis lethargica</a></li></ul></li> <li><a href="/wiki/Cavernous_sinus_thrombosis" title="Cavernous sinus thrombosis">Cavernous sinus thrombosis</a></li> <li><a href="/wiki/Brain_abscess" title="Brain abscess">Brain abscess</a> <ul><li><a href="/wiki/Amoebic_brain_abscess" title="Amoebic brain abscess">Amoebic</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Brain and <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalomyelitis" title="Encephalomyelitis">Encephalomyelitis</a> <ul><li><a href="/wiki/Acute_disseminated_encephalomyelitis" title="Acute disseminated encephalomyelitis">Acute disseminated</a></li></ul></li> <li><a href="/wiki/Meningitis" title="Meningitis">Meningitis</a></li> <li><a href="/wiki/Meningoencephalitis" title="Meningoencephalitis">Meningoencephalitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a>/<br /><a href="/wiki/Encephalopathy" title="Encephalopathy">encephalopathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Extrapyramidal_system" title="Extrapyramidal system">Extrapyramidal</a> and<br /><a href="/wiki/Movement_disorders" class="mw-redirect" title="Movement disorders">movement disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Basal_ganglia_disease" title="Basal ganglia disease">Basal ganglia disease</a> <ul><li><a href="/wiki/Parkinsonism" title="Parkinsonism">Parkinsonism</a> <ul><li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">PD</a></li> <li><a href="/wiki/Postencephalitic_parkinsonism" class="mw-redirect" title="Postencephalitic parkinsonism">Postencephalitic</a></li> <li><a href="/wiki/Neuroleptic_malignant_syndrome" title="Neuroleptic malignant syndrome">NMS</a></li></ul></li> <li><a href="/wiki/Neurodegeneration_with_brain_iron_accumulation" title="Neurodegeneration with brain iron accumulation">NBIA</a> <ul><li><a href="/wiki/Pantothenate_kinase-associated_neurodegeneration" title="Pantothenate kinase-associated neurodegeneration">PKAN</a></li></ul></li> <li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Progressive_supranuclear_palsy" title="Progressive supranuclear palsy">PSP</a></li></ul></li> <li><a href="/wiki/Multiple_system_atrophy" title="Multiple system atrophy">Striatonigral degeneration</a></li> <li><a href="/wiki/Hemiballismus" title="Hemiballismus">Hemiballismus</a></li> <li><a href="/wiki/Huntington%27s_disease" title="Huntington's disease">HD</a></li> <li><a href="/wiki/Olivopontocerebellar_atrophy" class="mw-redirect" title="Olivopontocerebellar atrophy">OA</a></li></ul></li></ul> <ul><li><a href="/wiki/Dyskinesia" title="Dyskinesia">Dyskinesia</a> <ul><li><a href="/wiki/Dystonia" title="Dystonia">Dystonia</a> <ul><li><a href="/wiki/Status_dystonicus" title="Status dystonicus">Status dystonicus</a></li> <li><a href="/wiki/Spasmodic_torticollis" title="Spasmodic torticollis">Spasmodic torticollis</a></li> <li><a href="/wiki/Meige%27s_syndrome" title="Meige's syndrome">Meige's</a></li> <li><a href="/wiki/Blepharospasm" title="Blepharospasm">Blepharospasm</a></li></ul></li> <li><a href="/wiki/Athetosis" title="Athetosis">Athetosis</a></li> <li><a href="/wiki/Chorea" title="Chorea">Chorea</a> <ul><li><a href="/wiki/Choreoathetosis" title="Choreoathetosis">Choreoathetosis</a></li></ul></li> <li><a href="/wiki/Myoclonus" title="Myoclonus">Myoclonus</a> <ul><li><a href="/wiki/Myoclonic_epilepsy" title="Myoclonic epilepsy">Myoclonic epilepsy</a></li></ul></li> <li><a href="/wiki/Akathisia" title="Akathisia">Akathisia</a></li></ul></li></ul> <ul><li><a href="/wiki/Tremor" title="Tremor">Tremor</a> <ul><li><a href="/wiki/Essential_tremor" title="Essential tremor">Essential tremor</a></li> <li><a href="/wiki/Intention_tremor" title="Intention tremor">Intention tremor</a></li></ul></li> <li><a href="/wiki/Restless_legs_syndrome" title="Restless legs syndrome">Restless legs</a></li> <li><a href="/wiki/Stiff-person_syndrome" title="Stiff-person syndrome">Stiff-person</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dementia" title="Dementia">Dementia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's</a> <ul><li><a href="/wiki/Early-onset_Alzheimer%27s_disease" title="Early-onset Alzheimer's disease">Early-onset</a></li></ul></li> <li><a href="/wiki/Primary_progressive_aphasia" title="Primary progressive aphasia">Primary progressive aphasia</a></li></ul></li> <li><a href="/wiki/Frontotemporal_dementia" title="Frontotemporal dementia">Frontotemporal dementia</a>/<a href="/wiki/Frontotemporal_lobar_degeneration" title="Frontotemporal lobar degeneration">Frontotemporal lobar degeneration</a> <ul><li><a href="/wiki/Pick%27s_disease" class="mw-redirect" title="Pick's disease">Pick's</a></li></ul></li> <li><a href="/wiki/Lewy_bodies_dementia" class="mw-redirect" title="Lewy bodies dementia">Lewy bodies dementia</a></li> <li><a href="/wiki/Posterior_cortical_atrophy" title="Posterior cortical atrophy">Posterior cortical atrophy</a></li></ul> <p><a href="/wiki/Creutzfeldt%E2%80%93Jakob_disease" title="Creutzfeldt–Jakob disease">Creutzfeldt–Jakob disease</a> </p> <ul><li><a href="/wiki/Vascular_dementia" title="Vascular dementia">Vascular dementia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mitochondrial_disease" title="Mitochondrial disease">Mitochondrial disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Leigh_syndrome" title="Leigh syndrome">Leigh syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Demyelinating_disease" title="Demyelinating disease">Demyelinating</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/CNS_demyelinating_autoimmune_diseases" title="CNS demyelinating autoimmune diseases">Autoimmune</a></li> <li><a href="/wiki/Inflammatory_demyelinating_diseases_of_the_central_nervous_system" title="Inflammatory demyelinating diseases of the central nervous system">Inflammatory</a></li> <li><a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">Multiple sclerosis</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Demyelinating_diseases_of_CNS" title="Template:Demyelinating diseases of CNS">Template:Demyelinating diseases of CNS</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Episodic/<br /><a href="/wiki/Paroxysmal_attack" title="Paroxysmal attack">paroxysmal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">Seizures</a> and <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Focal_seizure" title="Focal seizure">Focal</a></li> <li><a href="/wiki/Generalized_epilepsy" title="Generalized epilepsy">Generalised</a></li> <li><a href="/wiki/Status_epilepticus" title="Status epilepticus">Status epilepticus</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Epilepsy" class="mw-redirect" title="Template:Epilepsy">Template:Epilepsy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Headache" title="Headache">Headache</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Migraine" title="Migraine">Migraine</a></li> <li><a href="/wiki/Cluster_headache" title="Cluster headache">Cluster</a></li> <li><a href="/wiki/Tension_headache" title="Tension headache">Tension</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Headache" title="Template:Headache">Template:Headache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrovascular_disease" title="Cerebrovascular disease">Cerebrovascular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Transient_ischemic_attack" title="Transient ischemic attack">TIA</a></li> <li><a href="/wiki/Stroke" title="Stroke">Stroke</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Cerebrovascular_diseases" title="Template:Cerebrovascular diseases">Template:Cerebrovascular diseases</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_disorders" class="mw-redirect" title="Sleep disorders">Sleep disorders</a> <ul><li>For more detailed coverage, see <a href="/wiki/Template:Sleep" title="Template:Sleep">Template:Sleep</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">CSF</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intracranial_pressure" title="Intracranial pressure">Intracranial hypertension</a> <ul><li><a href="/wiki/Hydrocephalus" title="Hydrocephalus">Hydrocephalus</a></li> <li><a href="/wiki/Normal_pressure_hydrocephalus" title="Normal pressure hydrocephalus">Normal pressure hydrocephalus</a></li> <li><a href="/wiki/Choroid_plexus_papilloma" title="Choroid plexus papilloma">Choroid plexus papilloma</a></li> <li><a href="/wiki/Idiopathic_intracranial_hypertension" title="Idiopathic intracranial hypertension">Idiopathic intracranial hypertension</a></li></ul></li> <li><a href="/wiki/Cerebral_edema" title="Cerebral edema">Cerebral edema</a></li> <li><a href="/wiki/Spontaneous_cerebrospinal_fluid_leak" class="mw-redirect" title="Spontaneous cerebrospinal fluid leak">Intracranial hypotension</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Brain herniation</a></li> <li><a href="/wiki/Reye_syndrome" title="Reye syndrome">Reye syndrome</a></li> <li><a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a></li> <li><a href="/wiki/Toxic_encephalopathy" title="Toxic encephalopathy">Toxic encephalopathy</a></li> <li><a href="/wiki/Hashimoto%27s_encephalopathy" title="Hashimoto's encephalopathy">Hashimoto's encephalopathy</a></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Static encephalopathy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Both/either</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Degenerative" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinocerebellar_ataxia" title="Spinocerebellar ataxia">SA</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Friedreich%27s_ataxia" title="Friedreich's ataxia">Friedreich's ataxia</a></li> <li><a href="/wiki/Ataxia%E2%80%93telangiectasia" title="Ataxia–telangiectasia">Ataxia–telangiectasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Motor_neuron_diseases" title="Motor neuron diseases">MND</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Upper_motor_neuron" title="Upper motor neuron">UMN</a> only:</i> <ul><li><a href="/wiki/Primary_lateral_sclerosis" title="Primary lateral sclerosis">Primary lateral sclerosis</a></li> <li><a href="/wiki/Pseudobulbar_palsy" title="Pseudobulbar palsy">Pseudobulbar palsy</a></li> <li><a href="/wiki/Hereditary_spastic_paraplegia" title="Hereditary spastic paraplegia">Hereditary spastic paraplegia</a></li></ul></li></ul> <ul><li><i><a href="/wiki/Lower_motor_neuron" title="Lower motor neuron">LMN</a> only:</i> <ul><li><a href="/wiki/Distal_hereditary_motor_neuronopathies" title="Distal hereditary motor neuronopathies">Distal hereditary motor neuronopathies</a></li> <li><a href="/wiki/Spinal_muscular_atrophies" title="Spinal muscular atrophies">Spinal muscular atrophies</a> <ul><li><a href="/wiki/Spinal_muscular_atrophy" title="Spinal muscular atrophy">SMA</a></li> <li><a href="/wiki/Spinal_and_bulbar_muscular_atrophy" title="Spinal and bulbar muscular atrophy">SMAX1</a></li> <li><a href="/wiki/X-linked_spinal_muscular_atrophy_type_2" title="X-linked spinal muscular atrophy type 2">SMAX2</a></li> <li><a href="/wiki/Distal_spinal_muscular_atrophy_type_1" title="Distal spinal muscular atrophy type 1">DSMA1</a></li> <li><a href="/wiki/Congenital_distal_spinal_muscular_atrophy" title="Congenital distal spinal muscular atrophy">Congenital DSMA</a></li> <li>Spinal muscular atrophy with lower extremity predominance (SMALED) <ul><li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_1" title="Spinal muscular atrophy with lower extremity predominance 1">SMALED1</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2A" title="Spinal muscular atrophy with lower extremity predominance 2A">SMALED2A</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2B" title="Spinal muscular atrophy with lower extremity predominance 2B">SMALED2B</a></li></ul></li> <li><a href="/wiki/Pontocerebellar_hypoplasia" title="Pontocerebellar hypoplasia">SMA-PCH</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_progressive_myoclonic_epilepsy" title="Spinal muscular atrophy with progressive myoclonic epilepsy">SMA-PME</a></li></ul></li> <li><a href="/wiki/Progressive_muscular_atrophy" title="Progressive muscular atrophy">Progressive muscular atrophy</a></li> <li><a href="/wiki/Progressive_bulbar_palsy" title="Progressive bulbar palsy">Progressive bulbar palsy</a> <ul><li><a href="/wiki/Fazio%E2%80%93Londe_disease" title="Fazio–Londe disease">Fazio–Londe</a></li> <li><a href="/wiki/Infantile_progressive_bulbar_palsy" title="Infantile progressive bulbar palsy">Infantile progressive bulbar palsy</a></li></ul></li></ul></li></ul> <ul><li><i>both:</i> <ul><li><a href="/wiki/Amyotrophic_lateral_sclerosis" class="mw-redirect" title="Amyotrophic lateral sclerosis">Amyotrophic lateral sclerosis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Neurotrauma" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Neurotrauma" title="Template:Neurotrauma"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Neurotrauma" title="Template talk:Neurotrauma"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Neurotrauma" title="Special:EditPage/Template:Neurotrauma"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Neurotrauma" style="font-size:114%;margin:0 4em"><a href="/wiki/Brain_injury" title="Brain injury">Neurotrauma</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">Traumatic brain injury</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intracranial_hemorrhage" title="Intracranial hemorrhage">Intracranial hemorrhage</a></li> <li>Intra-axial <ul><li><a href="/wiki/Intraparenchymal_hemorrhage" title="Intraparenchymal hemorrhage">Intraparenchymal hemorrhage</a></li> <li><a href="/wiki/Intraventricular_hemorrhage" title="Intraventricular hemorrhage">Intraventricular hemorrhage</a></li></ul></li> <li>Extra-axial <ul><li><a href="/wiki/Subdural_hematoma" title="Subdural hematoma">Subdural hematoma</a></li> <li><a href="/wiki/Epidural_hematoma" title="Epidural hematoma">Epidural hematoma</a></li> <li><a href="/wiki/Subarachnoid_hemorrhage" title="Subarachnoid hemorrhage">Subarachnoid hemorrhage</a></li></ul></li> <li><a class="mw-selflink selflink">Brain herniation</a></li> <li><a href="/wiki/Cerebral_contusion" title="Cerebral contusion">Cerebral contusion</a></li> <li><a href="/wiki/Cerebral_laceration" title="Cerebral laceration">Cerebral laceration</a></li> <li><a href="/wiki/Concussion" title="Concussion">Concussion</a> <ul><li><a href="/wiki/Post-concussion_syndrome" title="Post-concussion syndrome">Post-concussion syndrome</a></li> <li><a href="/wiki/Second-impact_syndrome" title="Second-impact syndrome">Second-impact syndrome</a></li> <li><a href="/wiki/Dementia_pugilistica" class="mw-redirect" title="Dementia pugilistica">Dementia pugilistica</a></li> <li><a href="/wiki/Chronic_traumatic_encephalopathy" title="Chronic traumatic encephalopathy">Chronic traumatic encephalopathy</a></li></ul></li> <li><a href="/wiki/Diffuse_axonal_injury" title="Diffuse axonal injury">Diffuse axonal injury</a></li> <li><a href="/wiki/Abusive_head_trauma" class="mw-redirect" title="Abusive head trauma">Abusive head trauma</a></li> <li><a href="/wiki/Penetrating_head_injury" title="Penetrating head injury">Penetrating head injury</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinal_cord_injury" title="Spinal cord injury">Spinal cord injury</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anterior_spinal_artery_syndrome" title="Anterior spinal artery syndrome">Anterior spinal artery syndrome</a></li> <li><a href="/wiki/Brown-S%C3%A9quard_syndrome" title="Brown-Séquard syndrome">Brown-Séquard syndrome</a></li> <li><a href="/wiki/Cauda_equina_syndrome" title="Cauda equina syndrome">Cauda equina syndrome</a></li> <li><a href="/wiki/Central_cord_syndrome" title="Central cord syndrome">Central cord syndrome</a></li> <li><a href="/wiki/Paraplegia" title="Paraplegia">Paraplegia</a></li> <li><a href="/wiki/Posterior_cord_syndrome" class="mw-redirect" title="Posterior cord syndrome">Posterior cord syndrome</a></li> <li><a href="/wiki/Spinal_cord_injury_without_radiographic_abnormality" title="Spinal cord injury without radiographic abnormality">Spinal cord injury without radiographic abnormality</a></li> <li><a href="/wiki/Tetraplegia" title="Tetraplegia">Tetraplegia</a> (Quadriplegia)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peripheral_nervous_system" title="Peripheral nervous system">Peripheral nerves</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nerve_injury" title="Nerve injury">Nerve injury</a> <ul><li><a href="/wiki/Peripheral_nerve_injury" class="mw-redirect" title="Peripheral nerve injury">Peripheral nerve injury</a></li> <li><a href="/wiki/Peripheral_nerve_injury_classification" class="mw-redirect" title="Peripheral nerve injury classification">classification</a></li></ul></li> <li><a href="/wiki/Wallerian_degeneration" title="Wallerian degeneration">Wallerian degeneration</a></li> <li><a href="/wiki/Accessory_nerve_disorder" title="Accessory nerve disorder">Injury of accessory nerve</a></li> <li><a href="/wiki/Brachial_plexus_injury" title="Brachial plexus injury">Brachial plexus injury</a></li> <li><a href="/wiki/Traumatic_neuroma" title="Traumatic neuroma">Traumatic neuroma</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" 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