Normally, an ipsilateral fixed and dilated pupil suggests lateral transtentorial
herniation, while bilaterally fixed and dilated pupils are consistent with central transtentorial
herniation in a fully resuscitated patient.
Imaging findings include a sunken skin flap with herniation of the brain away from the craniectomy defect, which results in subfalcine or transtentorial
Two patients had fatal cerebral edema and transtentorial
brain herniation syndrome associated with ARDS and renal failure (12).
There was subfalcine and transtentorial
herniation and death can ensue with progression of a thrombus to the anterior and middle cerebral arteries that produces infarction, edema and mass effect.
Using totality as a surrogate for irreversibility assumes that all cases of irreversible apneic coma are the endpoint of the classical rostral-caudal sequence of brain destruction caused by transtentorial
Petrosal presigmoid approach to the petro-clival and anterior cerebellopontine region (extended retrolabyrinthine, transtentorial
herniation secondary to increased intracranial pressure was thought to be the cause of death.
Dilated ventricles, indicating hydrocephalus, were seen in 2 of 6 patients and evidence of transtentorial
herniation was present in 4 of 6 patients.
A repeat head computed tomography scan showed marked edema and transtentorial
herniation, and a ventricular drain was placed.
Each is associated with vasogenic edema, but there is no midline shift or subfalcine or transtentorial
Left uncal herniation and descending transtentorial
herniation were noted.