Subdural hemorrhage with subfalcine and uncal herniation

Case contributed by Dr Euan Zhang



Patient Data

Age: 75 years
Gender: Male

There is a moderate volume of chronic subdural hemorrhage over the left frontal convexity causing a midline shift of 1 cm, rightward uncal herniation, and rightward transtentorial herniation.

Diagrams showing how to measure midline shift and how to identify uncal and transtentorial herniation.

Case Discussion

This case is a good example of mild degree of subfalcine, uncal, and transtentorial herniations.

To measure midline shift, draw a line through the midline and measure the displacement of the septum pellucidum. It is a good marker of the shift of the cingulate gyrus (which is the structure that herniates under the falx in a subfalcine herniation). 

To find the uncus, locate the coronal slice showing the basilar artery. The uncus should be at that slice, or an adjacent slight.

To identify transtentorial herniation, scroll to the mid aspect of the falx but anterior to the incisura, and identify any brain parenchyma protruding lower than an imaginary line from the margin of the tentorium to the falx.

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Case information

rID: 66580
Published: 26th Feb 2019
Last edited: 28th Apr 2020
Inclusion in quiz mode: Included

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