Unkal/descending transtentorial herniasyon

Özet

Supratentoryal kitle etkisi medial temporal lobu, özellikle unkus ve parahipokampal girusu tentoryal açıklığa doğru iter. Kontrastsız BT’de beyin yapılarının yer değiştirmesi, bazal BOS sisternlerinde bası ve herniasyon bulguları değerlendirilir. Unkal herniasyonda mezensefalon ve ipsilateral üçüncü kraniyal sinir bası altında kalabilir. Orta hat kaymasına ek olarak bazal BOS sisternlerinin basısı da BT'de beyin herniasyonu bulgusu olarak değerlendirilmelidir.

Okuma sırası

1. unkus ve tentoryal incisura. Mezensefalon kesitinde medial temporal lobun medial ve aşağı konturunu takip et; unkus tentoryal açıklıkla normalde olmayan temas veya taşma gösteriyor mu bak.
2. suprasellar sistern. Suprasellar sisterni karşı tarafla karşılaştır; tek taraflı kapanma kitle etkisinin erken anatomik izlerinden biridir.
3. ambient sistern ve mezensefalon. Ambient sisternlerin genişlik farkını ve mezensefalonun yerini/rotasyonunu incele; sistern değişikliğinin beyin sapını hangi yöne ittiğini belirle.
4. temporal horn, PCA alanı ve serebral pedinküller. Son olarak temporal horn basısı, PCA komşuluğunda oksipital iskemi ve pedinkül basısı gibi eşlik eden sonuçları ara.

Bu konu için açık lisanslı ve doğrulanmış bir olgu görüntüsü henüz bulunamadı.

Faz ve pencere

Kontrastsız tanısal

Aşağı transtentoryal herniasyonda beyin dokusu tentoryal açıklıktan aşağı yer değiştirir; yanal herniasyonda medial temporal lob, anterior yer değiştirmede unkus ve posterior yer değiştirmede parahipokampal girus etkilenir.

BT bulguları

• Unkus ve parahipokampal girusun tentoryal kenara doğru inferomedial yer değiştirmesi
• İpsilateral suprasellar veya interpedinküler sisternin daralması ya da silinmesi
• Ambient sisternlerde asimetri; ipsilateral tarafta gerilme, karşı tarafta bası görülebilmesi
• Mezensefalonun yana itilmesi, rotasyonu veya konturunun basılanması
• PCA'nın tentoryal kenardaki komşuluğunda bası ve gelişmişse oksipital enfarkt bulguları
• İleri basıda karşı serebral pedinkülün tentoryal kenara dayanmasına bağlı Kernohan çentiği

Normalde

Normal mezensefalon düzeyinde suprasellar ve ambient sisternler BOS dansitesinde, açık ve yaklaşık simetriktir; medial temporal lob tentoryal incisuraya taşmaz. Aynı tarafta unkus ile sistern arasındaki aralığı, karşı ambient sisterni ve mezensefalonun merkez/rotasyonunu yan yana kıyasla.

Ayırıcı tanı

Santral aşağı transtentoryal herniasyonda diencephalon, mezensefalon ve pons aşağı doğru yer değiştirir.

Normal sisternal asimetri

karşılaştırmalı görüntüde lezyona bağlı kitle etkisi, temporal horn itilmesi ve beyin sapı rotasyonu eşlik etmez

Santral herniasyonda diencephalon, mezensefalon ve pons aşağı yer değiştirirken lateral aşağı transtentoryal herniasyonda medial temporal lob yapıları yer değiştirir.

Tuzaklar

• Posterior fossada kafatası tabanından kaynaklanan ışın sertleşme artefaktı görüntü kalitesini düşürerek küçük damarların değerlendirilmesini güçleştirebilir.
• Lateral aşağı transtentoryal herniasyonda anterior yer değiştirme unkusu, posterior yer değiştirme parahipokampal girusu içerir.

Kendini dene

1. Aşağı transtentoryal herniasyonun anterior tipinde hangi yapı yer değiştirir?

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

   Unkus. Anterior aşağı transtentoryal herniasyon, unkusun yer değiştirmesiyle tanımlanır.

2. Aşağı transtentoryal herniasyonun anterior tipinde hangi yapı tentoryal açıklığa yer değiştirir?

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

   Unkus. Anterior aşağı transtentoryal herniasyon, unkusun tentoryal açıklığa yer değiştirmesiyle tanımlanır.

İlgili konular

• Travmatik serebral ödem/şişme
• Perihematomal ödem
• Subfalsin herniasyon
• Santral aşağı transtentorial herniasyon

Kaynaklar

Bu sayfadaki 27 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Brain Shift Patterns: Upward, Lateral and Downward Herniation, Its Correlation with Clinical Patterns in Acute Intracranial Pathologies and Neurosurgical Managementpmc.ncbi.nlm.nih.gov
2. A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Departmentpmc.ncbi.nlm.nih.gov
3. Kernohan-Woltman Notch Phenomenon: A Case of Paradoxical Hemiparesispmc.ncbi.nlm.nih.gov
4. 7295 Giant Pituitary Adenoma with Rapid Symptomatic Progression and Postoperative Mortalitypmc.ncbi.nlm.nih.gov
5. Case Report: Subgaleal drainage removal results in a fatal complication after burr-hole evacuation of chronic subdural hematomapmc.ncbi.nlm.nih.gov
6. The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation, Surgical Management, and Functional Prognosis.pubmed.ncbi.nlm.nih.gov
7. Recent Advances in Pathophysiology of Traumatic Brain Injury.pubmed.ncbi.nlm.nih.gov
8. MDCT imaging of traumatic brain injury.pubmed.ncbi.nlm.nih.gov
9. Imaging for the diagnosis and management of traumatic brain injury.pubmed.ncbi.nlm.nih.gov
10. Imaging Evaluation of Acute Traumatic Brain Injury.pubmed.ncbi.nlm.nih.gov
11. Fetal intracranial hemorrhage and infarct: Main sonographic and MRI characteristics: A review article.pubmed.ncbi.nlm.nih.gov
12. Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review.pubmed.ncbi.nlm.nih.gov
13. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation.pubmed.ncbi.nlm.nih.gov
14. Delineation of Subarachnoid Cisterns Using CT Cisternography, CT Brain Positive and Negative Contrast, and a Three Dimensional MRI Sequence: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
15. Development of the SIMPLE scoring system for predicting malignant brain edema in patients with large hemispheric infarction following acute ischemic stroke.pubmed.ncbi.nlm.nih.gov
16. Navigating the Role of Surgery in Optimizing Patient Outcomes in Traumatic Brain Injuries (TBIs): A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
17. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment.pubmed.ncbi.nlm.nih.gov
18. Case Report: The molecular profile of granular cell astrocytoma predicts aggressive clinical behavior, independent of morphology.pubmed.ncbi.nlm.nih.gov
19. Anatomy-Guided Microsurgical Resection of a Dominant Frontal Lobe Tumor Without Intraoperative Adjuncts: A Case Report from a Resource-Limited Context.pubmed.ncbi.nlm.nih.gov
20. Status epilepticus secondary to hyperammonaemia: a late presentation of an undiagnosed urea cycle defect.pubmed.ncbi.nlm.nih.gov
21. Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study.pubmed.ncbi.nlm.nih.gov
22. Vitamin K deficiency bleeding presenting as impending brain herniation.pubmed.ncbi.nlm.nih.gov
23. Case Report: Reversible acquired Chiari-like state and upper cervical syringomyelia caused by a giant posterior tentorial tumor confined to the supratentorial compartment.pubmed.ncbi.nlm.nih.gov
24. A multidisciplinary approach to management of a non-traumatic subdural hematoma in the third trimester of pregnancy: A case report and review of literature.pubmed.ncbi.nlm.nih.gov
25. Elevated intracranial pressure requiring decompressive craniectomy in a child with progressive primary angiitis of the central nervous system: a case report.pubmed.ncbi.nlm.nih.gov
26. Brain Shift Patterns: Upward, Lateral and Downward Herniation, Its Correlation with Clinical Patterns in Acute Intracranial Pathologies and Neurosurgical Management.pubmed.ncbi.nlm.nih.gov
27. A Review of the Clinical Presentation, Causes, and Diagnostic Evaluation of Increased Intracranial Pressure in the Emergency Department.pubmed.ncbi.nlm.nih.gov
28. Kernohan-Woltman Notch Phenomenon: A Case of Paradoxical Hemiparesis.pubmed.ncbi.nlm.nih.gov
29. Possible delayed neuronal death after seemingly successful evacuation of traumatic acute subdural hematoma: Image report.pubmed.ncbi.nlm.nih.gov
30. Rapid spontaneous regression of a massive post-thrombolysis intracerebral hemorrhage: A case report.pubmed.ncbi.nlm.nih.gov
31. Post-traumatic hydrocephalus in adults: the mechanisms of development, predictors of progression and management strategies. A narrative review and case series analysis.pubmed.ncbi.nlm.nih.gov
32. Coma and cerebral imaging.pubmed.ncbi.nlm.nih.gov
33. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring.pubmed.ncbi.nlm.nih.gov
34. Safety and tolerability of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial.pubmed.ncbi.nlm.nih.gov
35. The role of neuroimaging in the determination of brain death.pubmed.ncbi.nlm.nih.gov
36. Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
37. An overview of management of intracranial hypertension in the intensive care unit.pubmed.ncbi.nlm.nih.gov
38. Application of Transcranial Sonography for the Assessment of Brain Midline Shift in Patients Presenting With Suspected Intracranial Pathology to the Emergency Department of a Tertiary Care Hospital in Central Gujarat, India.pubmed.ncbi.nlm.nih.gov
39. Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery: A two-year study at Kilimanjaro Christian Medical Centre, Tanzania.pubmed.ncbi.nlm.nih.gov
40. Review of imaging modalities and radiological findings of calvarial lesions.pubmed.ncbi.nlm.nih.gov
41. Ruptured Vertebral-Anterior Spinal Artery Junction Aneurysm Presenting With Diffuse Subarachnoid Hemorrhage: Diagnostic Limitations of CT Angiography (CTA) and the Role of Digital Subtraction Angiography (DSA) in Management-Related Decision-Making.pubmed.ncbi.nlm.nih.gov
42. An interpretable multimodal model for early prediction of delayed hematoma progression in frontal lobe contusion: a machine learning approach.pubmed.ncbi.nlm.nih.gov
43. Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
44. Intra-articular steroid injections for lumbar disk herniation: a systematic review and meta-analysis.pubmed.ncbi.nlm.nih.gov
45. Disseminated Intracranial and Spinal Dysembryoplastic Neuroepithelial Tumor: A Case Report with a Systematic Review.pubmed.ncbi.nlm.nih.gov
46. Surgical management of cerebral venous sinus thrombosis: Case series and literature review.pubmed.ncbi.nlm.nih.gov
47. Cerebral Salt-Wasting Syndrome in Severe Brain Trauma: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
48. Anisocoria without extraocular muscle impairment due to moderate traumatic brain injury with midbrain contusion: a case report.pubmed.ncbi.nlm.nih.gov
49. Traumatic Brain Injury With Concomitant Myocardial Infarction: A Clinical Dilemma.pubmed.ncbi.nlm.nih.gov
50. A Discussion of a Case of Paradoxical Ipsilateral Hemiparesis in a Patient Diagnosed with Pterional Meningioma.pubmed.ncbi.nlm.nih.gov
51. Optimal Timing for Stereotactic Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage With Tentorial Herniation: A Retrospective Study.pubmed.ncbi.nlm.nih.gov
52. CT pattern of Infarct location and not infarct volume determines outcome after decompressive hemicraniectomy for Malignant Middle Cerebral Artery Stroke.pubmed.ncbi.nlm.nih.gov
53. Initial Experience With a Deep Learning Algorithm for Detecting Posterior Circulation Large Vessel Occlusion on Noncontrast Computed Tomography.pubmed.ncbi.nlm.nih.gov
54. Current Management and Image Review of Skull Base Chordoma: What the Radiologist Needs to Know.pubmed.ncbi.nlm.nih.gov
55. Giant hemorrhagic and abscessed pediatric high-grade glioma with osteolysis and transcalvarial herniation: A unique presentation and literature review.pubmed.ncbi.nlm.nih.gov
56. The Ocular Signature of TBI: A Narrative Review of Structural Changes and Potential Candidate Biomarkers.pubmed.ncbi.nlm.nih.gov
57. Differential Diagnosis of Tumor-like Brain Lesions.pubmed.ncbi.nlm.nih.gov
58. Tranexamic acid in the management of traumatic brain injury: a systematic review and meta-analysis with trial sequential analysis.pubmed.ncbi.nlm.nih.gov
59. Ectopic craniopharyngioma recurrence: a case report and literature review.pubmed.ncbi.nlm.nih.gov
60. Endoscopic endonasal transsphenoidal surgery in children: widening the spectrum of oncological indications in the pediatric age group.pubmed.ncbi.nlm.nih.gov
61. Endoscopic endonasal resection of a craniopharyngioma in a 23-month-old patient: illustrative case.pubmed.ncbi.nlm.nih.gov
62. Predicting infarction growth rate II using ANFIS-based binary particle swarm optimization technique in ischemic stroke.pubmed.ncbi.nlm.nih.gov
63. Automated vs. manual coding of neuroimaging reports via natural language processing, using the international classification of diseases, tenth revision.pubmed.ncbi.nlm.nih.gov
64. Diagnostic neuroimaging in neuro-ophthalmic disorders.pubmed.ncbi.nlm.nih.gov
65. Neuroimaging in traumatic brain imaging.pubmed.ncbi.nlm.nih.gov
66. Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance.pubmed.ncbi.nlm.nih.gov
67. Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty.pubmed.ncbi.nlm.nih.gov
68. Endoscopic supracerebellar transtentorial approach for amygdalohippocampectomy (ESTAH): an anatomic study of the minimally invasive keyhole technique.pubmed.ncbi.nlm.nih.gov
69. Anatomy of the temporal lobe.pubmed.ncbi.nlm.nih.gov
70. Emergency burr-hole evacuation for subacute SDH with uncal herniation: a case report of near-complete neurological recovery despite bilateral occipital infarction.pubmed.ncbi.nlm.nih.gov
71. Noninvasive intracranial pressure monitoring methods: a critical review.pubmed.ncbi.nlm.nih.gov
72. Where Does the Signal Go? Technical Challenges of CT Perfusion in Lacunar and Infratentorial Stroke.pubmed.ncbi.nlm.nih.gov
73. Understanding Photon-Counting CT: Physics, Detector Technology, and Image Reconstructions.pubmed.ncbi.nlm.nih.gov
74. Neuroimaging with photon-counting computed tomography: A review of clinical applications.pubmed.ncbi.nlm.nih.gov
75. Acute Epidural Hematoma: From Injury to Death.pubmed.ncbi.nlm.nih.gov
76. Optimization of Posterior Fossa Image Quality Using Virtual Monoenergetic Reconstructions from Dual-Layer Spectral CT.pubmed.ncbi.nlm.nih.gov
77. The Imaging Compass: Navigating Reperfusion in Acute Ischemic Stroke.pubmed.ncbi.nlm.nih.gov
78. A case of spontaneous intracranial hypotension in a 45-year-old male with headache, behavior changes and altered mental status.pubmed.ncbi.nlm.nih.gov

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