Cerebral herniation

Case contributed by Dr Huda B. Gharbia

Presentation

One week after the of diagnosis of meningitis this boy presents with deteriorating level of consciousness and irregular respiration and coma.

Patient Data

Age: 10 years
Gender: Male
MRI

Brain MRI shows diffuse swelling of cerebral gyri and cerebellar cortex, appears hypointense on T1WI and hyperintense on T2WI, with effacement of sulci and CSF cisterns surrounding brain stem.

In addition bilateral medial part of temporal lobes protruding through tentorium, and inferior descent of cerebellar tonsils below the foramen magnum.

Case Discussion

This boy developed a complication of meningitis, with prominent brain edema, with uncal transtentorial herniation, caudal displacement of the brainstem, compression of pons and displacement of the cerebellar tonsils into the foramen magnum, compressing medulla and upper cervical spinal cord.

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