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Tentorial herniation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The clinical features of tentorial herniation include:

  • pupils dilated and unreactive to light:
    • due to compression of the III nerve and oculomotor nucleus
    • the palsy is unilateral at first - on the side of the lesion - but later becomes bilateral

  • ptosis or impaired eye movements:
    • may be difficult to discern if conscious level depressed
    • upward gaze is usually lost first because of pressure on the pretectum and superior colliculi

  • homonympus hemianopia - due to occlusion of posterior cerebral artery

  • limb weakness on same side of lesion:
    • a false localising sign - due to pressure from the edge of the tentorium on the opposite cerebral peduncle - Kernohan's notch

  • diabetes insipidus - from downward action on pituitary stalk and hypothalamus

  • may progress to tonsillar herniation

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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