Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most often the result of brain swelling from a head injury, stroke, or brain tumor.
Brain herniation is the most common side effect of tumors in the brain, including:
A brain and nervous system (neurological) exam shows changes in alertness (consciousness). Depending on the severity of the herniation and the part of the brain that is being pressed on, there will be problems with one or more brain-related reflexes and nerve functions.
Treatment
Brain herniation is a medical emergency. The goal of treatment is to save the patient's life.
To help reverse or prevent a brain herniation, the medical team will treat increased swelling and pressure in the brain. Treatment may involve:
Placing a drain into the brain to help remove cerebrospinal fluid (CSF)
Corticosteroids, such as dexamethasone, especially if there is a brain tumor, to reduce swelling
Medications that remove fluid from the body, such as mannitol or other diuretics, which reduce pressure inside the skull
Placing a tube in the airway (endotracheal intubation) and increasing the breathing rate to reduce the levels of carbon dioxide (CO2) in the blood
Removing blood or blood clots if they are raising pressure inside the skull and causing herniation
Removing part of the skull to give the brain more room
Expectations (prognosis)
The outlook varies and depends on where in the brain the herniation occurs. Without treatment, death is likely.
A brain herniation often causes a massive stroke. There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death.
Complications
Brain death
Permanent and significant neurologic problems
Calling your health care provider
Call your local emergency number (such as 911) or take the patient to a hospital emergency room if he or she develops decreased alertness or other symptoms, especially if there has been a head injury or if the person has a brain tumor or blood vessel problem.
Stippler M. Trauma of the Nervous System: Craniocerebral Trauma. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC,eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa:Saunders Elsevier; 2012:chap 50B.
Review Date:
8/29/2012
Reviewed By:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
