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-- Subfalcine (cingulate) herniation -- Uncal herniation (transtentorial herniation) -- Central herniation -- Transcalvarial herniation (through the calvarium)
What areas are supplied by the anterior cerebral arteries: Blue in picture.
--Herniation of the medial temporal lobe inferiorly through the tentorial notch.
Because the occulomotor nerve comes off the brain very close to there and is compressed by the herniated area. The parasympathetic fibers are located in the nerve external to the motor fibers --> therefore the blown pupil is seen first . . . later there may be motor deficits to the muscles supplied by III. -- blown pupil happens in 85% of cases
Why do we see hemiplegia (paralysis of half the body) with uncal herniation?
Because the motor axons in the cerebral peduncles are compressed: -- compressed isilateral to herniation: hemiplegia will be on the contralateral side of the body (axons decussate at pyramidal decussation) -- compressed contralateral to herniation: If the herniation is very severe, the contralateral cerebral peduncle may be compressed by the opposite side of the tentorial notch leading to an ipsilateral (to the herniation) hemiplegia (Kernohan's phenomenon).
-- unilateral or bilateral VI nerve palsy (pressure on nerve as it passes over the clivus) (mild cases) -- uncal herniation (severe cases) -- tonsillar herniation (downward cerebellar herniation) (very severe cases) -- stretch or tearing of small branches of the basilar artery --> this can be fatal.
-- can be due to trauma or a deliberate surgical opening of the skull to alleviate pressure or cerebral edema of the brain.
Usually caused by an expanding mass (tumor, blood) in the posterior fossa. The mass forces the medial cerebellum upward through the tentorial notch and compresses the midbrain.