Raised Intracranial Pressure

CLINICAL EFFECTS OF BRAIN SHIFT

TENTORIAL HERNIATION - Lateral

The posterior cerebral artery is sometimes occluded but the resultant homonymous hemianopia is rarely detected in the acute stage

Pressure against the reticular formation

The rate of symptom progression is related to the rate of lesion expansion.

in the midbrain causes deterioration of conscious level

Pressure against the reticular formation

The rate of symptom progression is related to the rate of lesion expansion.

in the midbrain causes deterioration of conscious level

Anterior cerebral artery nerve

Internal carotid artery

Pressure from the edge of the tentorium cerebelli on the opposite cerebral peduncle (Kernohan's notch) may produce limb weakness on the same side as the lesion i.e. 'false localising sign'

nerve

(Optic nerves and chiasma are not illustrated)

Internal carotid artery

Anterior cerebral artery

Compression of the nerve and oculomotor nucleus in the midbrain causes pupil dilatation and failure to react to light. Ptosis and impaired eye movements are less easy to detect due to the associated depression of conscious level.

TENTORIAL HERNIATION - Central

Pressure on dorsal aspect (pretectum and superior colliculi) impairs eye movements - upward gaze is initially lost

Diencephalon and midbrain damage from buckling and distortion and stretching of perforating vessels causes: deterioration of conscious level. Pupils initially small, become moderately dilated and fixed to light

Central tentorial herniation may progress to tonsillar herniation---

Pressure on dorsal aspect (pretectum and superior colliculi) impairs eye movements - upward gaze is initially lost

Downward traction on pituitary stalk and hypothalamus may cause diabetes insipidus

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