USMLE Neurology 20 Neuro Pathology: Herniations

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We are all done with neuro anatomy! Can you believe it? Well now that you understand the anatomy of the nervous system, we can discuss neuropathology. We start our first video on neuro pathology on a discussion of herniations.

The skull is a confined space and too much pressure can push structures and displace them. This is called herniation. There are there main structures that the brain can go through, including the falx cerebri, tentorium cerebelli, and the foramen magnum. This results in herniations including:

Cingulate (or subfalcine) herniation : herniation under the falx cerebri, which can compress the anterior cerebral artery.

Downward transtentorial (central) and uncal herniations: these deal with herniation through the tentorium cerebrelli. Downward herniations push the brainstem downward, which can cause Duret hemorrhages. Uncal herniations cause a myriad of symptoms, including CN III palsy (down and out), affect the ipsilateral PCA.

The last one is cerebellar tonsillar herniation, in which the cerebellar tonsils go through the foramen magnum. This again can compress the brain stem and cause death.