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3 out of 4

Which part of the brain herniates in central herniation?

A Temporal
B Frontal

C Thalamus
D Cerebellum

Ans. C


Central herniation

The diencephalon i.e. the thalamus and related structures that lie between upper brainstem and cerebral hemispheres are forced through the tentorium

1). It causes

Sequential compression occurs of the

a. Upper midbrain (first)

b. Pons (later)

c. Medulla (finally)

2). Physical signs

a. Early

i. Erratic respiration

ii. Small reactive pupils

iii. Increased limb tone

iv. Bilateral extensor plantar

b. Later:

i. Cheyne stokes respiration

ii. Decorticate rigidity

c. Still Later:

i. Fixed dilated pupils

ii. Decerebrate posturing