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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 58, Num. 6, 2010, pp. 953-954

Neurology India, Vol. 58, No. 6, November-December, 2010, pp. 953-954

Letter to Editor

Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note

Laszlo Novak1, Istvan Pataki2, Andrea Nagy2, Ervin Berenyi3

1 Department of Neurosurgery,University of Debrecen, Medical and Health Sciences Center, Hungary
2 Department of Pediatrics, University of Debrecen, Medical and Health Sciences Center, Hungary
3 Department of Biomedical Laboratory and Imaging Science, University of Debrecen, Medical and Health Sciences Center, Hungary
Correspondence Address: Laszlo Novak, Department of Neurosurgery,University of Debrecen, Medical and Health Sciences Center, Hungary, lnovak@dote.hu

Date of Acceptance: 06-Aug-2010

Code Number: ni10267

PMID: 21150069
DOI: 10.4103/0028-3886.73758

Sir,

In transtentorial herniation, downward shift of the uncus occurs through the tentorial incisura and often leads to death. The treatment is decompression. [1] Bilateral uncal herniation is typically seen in brain death. [2] Transtentorial herniation can cause occipital infarcts resulting in visual loss. [3] A 9-year-old boy was born at 29 th week of gestation as he had placental insufficiency. He needed resuscitation and suffered intraventricular hemorrhage in the early postnatal period. After ventricular drainage, he underwent ventriculo-peritoneal shunt implantation-initially, supratentorially; and later, infratentorially- because of the isolated and enlarged fourth ventricle. Altogether, he had undergone 33 interventions for various obstructive and infective complications. At this visit, he was ambulant with retarded cognitive functions (developmental age, 3-4 years). He used to get recurrent partial complex seizures of temporal semiology. Cranial magnetic resonance imaging (MRI) scan revealed bilateral transtentorial herniation [Figure - 1] with brainstem compression [Figure - 2]. Herniated unci resulted in pressure gradient causing the isolation of the infratentorial subarachnoid spaces. [4] Possibly, he could survive the bilateral transtentorial herniation as there was no ischemic brainstem injury. [4] To the best of our knowledge, this is the first demonstration of such phenomenon in a living person.

References

1.Mori K, Ishimaru S, Maeda M. Unco-parahippocampectomy for direct surgical treatment of downward transtentorial herniation. Acta Neurochir (Wien) 1998;140:1239-44.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Lovblad KO, Bassetti C. Diffusion-weighted magnetic resonance imaging in brain death. Stroke 2000;31:539-42.  Back to cited text no. 2    
3.Tanaka R, Miyasaka Y, Yada K, Mukuno K. Bilateral homonymous hemianopsia due to tentorial herniation, with sparing of central vision: Case report. Neurosurgery 1992;31:787-90.   Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Hussain SI, Cordero-Tumangday C, Goldenberg FD, Wollman R, Frank JI, Rosengart AJ. Brainstem ischemia in acute herniation syndrome. J Neurol Sci 2008;268:190-2.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]

Copyright 2010 - Neurology India

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