Brain herniation is a condition when brain tissue and cerebrospinal fluid (brain)cerebrospinal fluid) shifts from its normal position. This condition is triggered by swelling of the brain from a head injury, stroke, or brain tumor. Brain herniation is a very dangerous emergency if not treated immediately.
Types of Brain Herniation
Brain herniation can be divided into three types, based on where the brain tissue shifts, namely:
- Subfalcine. In this condition, the brain tissue moves down a layer called the falx cerebri. Subfalcine It is the most common type of brain herniation.
- Transtentorial. This type of herniation is divided into two, namely:
- Descending transtentorial, i.e. the condition when uncal (part of the side of the brain) shifts to the area posterior fossa (back of the brain).
- ascending transtentorial, is a condition of the cerebellum and brainstem that rises upward, passing through the tentorium cerebelli (the part that separates the cerebellum and cerebrum).
- Cerebellar tonsillar. This herniation occurs when cerebellar tonsils (lower part of the cerebellum) shifts downwards, passing through the foramen magnum (the hole at the bottom of the skull, which connects the brain and spine).
In addition to the three types above, brain herniation can also occur through a hole in the skull, which is made during brain surgery.
Symptoms of Brain Herniation
Brain herniation is a very dangerous condition if not treated immediately. Therefore, it is important to know the symptoms of this disease, including:
- It's hard to concentrate.
- High blood pressure.
- Body feels weak.
- Irregular pulse.
- Loss of body reflexes.
- Loss of brainstem reflexes, such as pupillary response to light and blinking.
- Cardiac arrest.
- Stop breathing.
Causes and Risk Factors of Brain Herniation
Brain herniation is caused by swelling of the brain. The swelling compresses and displaces brain tissue from its normal position. Brain herniation can be triggered by several conditions, such as:
- Head injury.
- Bleeding in the brain.
- Brain tumor.
- Abscess (collection of pus) in the brain, due to a bacterial or fungal infection.
- Hydrocephalus (buildup of fluid in the brain).
- Brain surgery procedures.
- An abnormality in the structure of the brain called a Chiari malformation.
- Vascular disease, such as a brain aneurysm.
Brain Herniation Diagnosis
To diagnose a brain herniation, the doctor will perform an X-ray examination of the patient's head and neck area. Other examination methods that can be done are CT scan and MRI. These imaging tests can help doctors see the inside of the head. If the doctor suspects an abscess in the brain, the patient will be asked to undergo a blood test.
Brain Herniation Treatment
Brain herniation treatment methods aim to reduce swelling and pressure in the brain, including the following procedures:
- Endoscopic ventriculostomy. This is a procedure of making a hole at the base of the brain, with the help of an endoscopic technique. Endoscopy ventriculostomy aims to remove brain fluid through the hole that has been made.
- Craniectomy. Craniectomy is the surgical removal of part of the skull, near the area of swelling. This procedure aims to reduce pressure in the brain, which if left unchecked will lead to permanent brain damage.
In addition to the above procedures, other methods for the treatment of brain herniation include:
- Surgery to remove tumors, blood clots, and abscesses.
- Administration of sedatives, anticonvulsants, or antibiotics.
- Administration of corticosteroids to reduce swelling.
- Endotracheal intubation or a breathing tube, to lower carbon dioxide levels in the blood.
- Osmotic diuretic drugs, such as mannitol or hypertonic fluids, to reduce fluid in brain tissue.
Complications of Brain Herniation
Brain herniation that is not treated immediately can be very dangerous and can cause:
- Permanent brain damage.
- Cardiac arrest.
- Brainstem death or brain death.