Subfalsin herniasyon

Özet

Tek hemisferdeki hematom, ödem veya kitle etkisi singulat girusu falx cerebri'nin serbest kenarının altına ve karşı tarafa iter. Kontrastsız beyin BT, bu yer değiştirmeyi ve eşlik eden ventrikül basısını hızla gösterdiği için akut değerlendirmede temel incelemedir. Falx komşuluğundaki perikallozal arter basısı iskemiye, foramen Monro düzeyindeki tıkanma ise karşı lateral ventrikülde genişlemeye yol açabilir. Herniasyon yaşamı tehdit eden bir durumdur ve acil dikkat gerektirir.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız beyin BT'de kitle etkisine eşlik eden ventrikül basısı ve subfalsin herniasyon değerlendirilebilir. Bu herniasyonun ilk değerlendirmesinde kontrast gerekmez.

Önerilen pencereler: Beyin (G 80 / M 40), Subdural (G 200 / M 75).

BT bulguları

• Singulat girusun falx cerebri'nin serbest alt kenarını aşarak karşı hemisfere uzanması
• Septum pellucidumun ve üçüncü ventrikülün kitle etkisinin karşı yönüne yer değiştirmesi
• Kitle tarafındaki lateral ventrikül frontal hornu veya gövdesinde basılanma
• Foramen Monro tıkanıklığına bağlı tek taraflı ventrikül genişlemesi görülebilir.
• Kitle etkisine bağlı orta hat sapmasında korpus kallozum yer değiştirebilir; ancak tanıda belirleyici olan singulat girusun falx altı geçişidir.
• Kitle etkisi ve eşlik eden ödem nedeniyle komşu sulkuslarda daralma veya silinme görülebilir.
• Perikallozal arter dahil ön serebral arter dallarının basısına bağlı olarak singulat girus ve medial korpus kallozumda infarkt gelişebilir.

Normalde

Normalde falx cerebri interhemisferik fissür içinde orta hatta uzanır; singulat giruslar falxın iki yanında kalır, septum pellucidum ve üçüncü ventrikül de orta hatta yer alır. Kıyaslamada bu anatomik sınırın aşılmasını, ventrikül konturlarındaki taraf farkını ve septum pellucidumun falxa göre konumunu birlikte incele.

Ayırıcı tanı

Fizyolojik ventrikül asimetrisi

frontal horn biçimleri farklı olabilir, ancak falx altında girus geçişi ve kitle etkisi bulunmaz

Serebral atrofi

sulkuslar ve ventriküller birlikte genişler; komşu ventrikül basısı beklenmez

Santral aşağı transtentoryal herniasyon

baskın yer değiştirme diensefalon ve mezensefalonun aşağı yönündedir

Unkal herniasyon

medial temporal lob tentoryal açıklığa yaklaşır ve perimezensefalik sisternleri asimetrik daraltır

Tuzaklar

• Septum pellucidumun tek başına deviasyonu herniasyonu kanıtlamaz; singulat girusun falxın altından geçtiğini komşu kesitlerde doğrula.
• Başın tarayıcı yatağındaki rotasyonu orta hat sapmasını olduğundan farklı gösterebilir; falxı üçüncü ventrikül ve kafa tabanı orta hattıyla beraber izle.
• Karşı lateral ventrikül genişlemesi tek başına obstrüktif hidrosefali diye yorumlanabilir; karşı frontal horn genişlemesini kitle tarafındaki horn basısı ve foramen Monro düzeyiyle eşleştir.
• Orta hat kayması herniasyonun anatomik kanıtı değildir; raporda singulat girusun falx altından geçişini ayrıca tarif et.

Kendini dene

1. Tek taraflı kitle etkisinde falxın altından karşıya yer değiştiren yapı hangisidir?

   • Singulat girus
   • Parahipokampal girus
   • Serebellar vermis
   • Serebellar tonsil
   Cevabı göster

   Singulat girus. Subfalsin herniasyonda medial frontal lobun singulat girusu falxın serbest kenarının altına geçer. Parahipokampal girus unkal, vermis yukarı transtentoryal, tonsiller ise tonsiller herniasyonla ilişkilidir.

2. Kitle tarafındaki frontal horn basılı, karşı frontal horn geniş görünüyorsa hangi yapıdaki tıkanıklık düşünülür?

   • Foramen Monro
   • Akuaduktus Sylvii
   • Luschka açıklığı
   • Magendie açıklığı
   Cevabı göster

   Foramen Monro. Foramen Monro tıkanması karşı lateral ventrikülün BOS çıkışını engelleyerek tek taraflı genişlemeye yol açabilir. Akuaduktus Sylvii üçüncü-dördüncü ventrikül arasındadır; Luschka ve Magendie açıklıkları dördüncü ventrikül çıkışlarıdır.

İlgili konular

• Travmatik serebral ödem/şişme
• Perihematomal ödem
• Unkal/descending transtentorial herniasyon
• Santral aşağı transtentorial herniasyon

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.