Upward transtentorial herniation: A new role for endoscopic third ventriculostomy

Background: The placement of external ventricular drainage (EVD) to treat hydrocephalus secondary to a cerebellar stroke is controversial because it has been associated to upward transtentorial herniation (UTH). This case illustrates the effectiveness of endoscopic third ventriculostomy (ETV) after the ascending herniation has occurred. Case Description: A 50-year-old man had a cerebellar stroke with hemorrhagic transformation, tonsillar herniation, and non-communicating obstructive hydrocephalus. Considering that the patient was anticoagulated and thrombocytopenic, an EVD was placed initially, followed by clinical deterioration and UTH. We performed a suboccipital craniectomy immediately after clinical worsening, but the patient did not show clinical or radiological improvement. On the 5th day, we did an ETV, which reverses the upward herniation and hydrocephalus. The patient improved progressively with good neurological recovery. Conclusion: ETV is an effective and safe procedure for obstructive hydrocephalus. The successful resolution of the patient’s upward herniation after the ETV offers a potential option to treat UTH and advocates further research in this area.

Loss of Vision Due to Bilateral Lateral Geniculate Body Infarction after Traumatic Brain Injury

In TBI patients, LPG infarction as a consequence of descending transtentorial herniation should be considered as a possible etiology of bilateral blindness.

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Traumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

Acts Aspect to the result of a cerebral hemorrhagic supratentorial session on the basics of analisys in the tentorial wedge

Cerebral transtentorial herniation determinates the course of progressive focal supratentorial impairments and acute hemorrhagic hemispheric stroke. Clinical and pathomorphological comparisons were done in patients with acute hemorrhagic hemispheric stroke. The following predictors of hemorrhagic hemispheric stroke lethal outcome were verified: 1) acute onset of coma in association with oculomotor dysfunctions; 2) focal hemiplegia in association with peduncular hemiplegia and paratonic rigiditydue due to compression of ipsilateral peduncle; 3) quick addition of vital disorders due to hemorrhagies into tectorium and it’s necrobiosis; 4) lethal outcome caused by herniation into occipital foramen due to necrobiosis of neurons in caudal part of brain stem tectorium.

False Localizing Sign

The Kernohan syndrome results from the compression of the cerebral peduncle against the tentorium cerebelli. This phenomenon represents a relevant clinical sign of transtentorial herniation due to an ipsilateral expansive lesion. We reported a case of a 50-year-old woman with a right temporal meningioma who developed a false localizing hemiparesis, which improved after microsurgical resection. This case emphasizes the mechanism and rarity of this pathology.