Central herniation

Last revised by Dr Yahya Baba on 14 Jan 2021

Central herniation is the subtype of downward transtentorial herniation of the brain that involves descent of the diencephalon and midbrain. It usually occurs with other types of downward herniation such as uncal herniation.

The clinical syndrome of central herniation classically manifests as a rostral to caudal progression of deficits attributed to brainstem dysfunction, including cranial nerve III (oculomotor nerve) palsy, diminished level of consciousness, decerebrate or decorticate posturing, rigidity or paralysis, abnormal respiratory pattern, and eventually death.

Central herniation is a late/severe sequela of supratentorial mass effect, especially when bilateral or midline. Potential etiologies include neoplasms, severe cerebral edema (e.g. from acute infarct), hemorrhage, and hydrocephalus.

Cross-sectional imaging (CT or MRI) demonstrates the following abnormalities 1,2:

Complications of central herniation include the following 2:

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Cases and figures

  • Figure 1: brain herniation types
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