MRI from a comatose patient with a massive acute subdural haematoma showed most of the features of transtentorial herniation described in the classic pathology literature. In addition to encroachment on the perimesencephalic cisterns, infarction in the anterior and posterior cerebral artery territories, ischaemic change in the lower diencephalon, and ventricular enlargement were visualised. Despite the clinical syndrome and these secondary changes due to compression, there was only approximately 2 mm of downward displacement of the upper brainstem compared with 13 mm horizontal displacement. Although tissue shifts adjacent to the tentorial aperture cause brainstem and vascular compression, these changes may occur with minimal downward herniation.
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| http://dx.doi.org/10.1136/jnnp.56.8.932 | DOI Listing |
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Article Synopsis
- Cortical blindness results from damage to the visual cortex, often due to strokes affecting the posterior cerebral arteries, which can occur during tentorial herniation.
- A case study of a 40-year-old patient with a large right-sided sphenoidal meningioma showed postoperative complications, including headaches, coma, and eventual detection of cortical blindness lasting 1.5 years despite the absence of other neurological symptoms.
- The case underscores the importance of recognizing risks associated with neurosurgery, as timely interventions may still lead to complications like irreversible ischemia, highlighting the need for patient awareness.
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