All are seen in cerebral herniation, except :
A i.e. Neck stiffnessNeck stiffness is seen in those condition in which the meninges are irritated e.g. meningitis.Herniation /ConingRefers to displacement of brain tissue away from a mass and into a compament that it normally does not occupy.UncalHerniationCentral transtentorialHerniationTransfalcialHerniationForaminalHerniationDisplacement of antero medial temporal gyrus(uncus) into the tentorial opening l/tSequential Compression of:Symmetric downward movement of upperthalamic region through tentorial opening 1/tSequential Compression of:Displacement ofcingulate gyrusunder the falxDownwardforcing of thecerebellar tonsil- Ipsilateral III cranial nv.- Upper midbrain (first)and across theinto the- Contralateral brainstem (later)- Pons (later)midlineforamen- Whole brainstem (eventually)- Medulla (finally) magnum.Physical Sign:Physical sign:EarlyLaterEventuallyEarlyLaterEventually- I/L dilated- Babinski- Tetraparesis- Erratic- Cheyne- FixedpupilQsignQ- B/L fixedrespirationstokesdilated- Sign of- I/Ldilated pupil- Small reactiverespirationpupilsupraten-hemiplegia- Erraticpupil- Decoicate- Decerebratetorial masslesion- AutonomicdisturbanceQrespiration- Death- B/L extensorplanterQrigidityposturing
Neck stiffness
Loss of consciousness
Pupil dilatation
Autonomic disturbances