The image on the left hand side shows herniation of the cere | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

The image on the left-hand side shows herniation of the cerebellar tonsils below the foramen magnum and effacement of the basilar cisterns. Contrast this with the image on the right-hand side from the same patient 5 months earlier. Tonsillar herniation can be caused by edema, masses, or overshunting. #NeuroWednesday

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Coronal (image 1) and axial (image 2) CT show herniation of a gyrus (arrow) through a remote right parietal skull fracture, which is further highlighted on a 3D reformatted image (image 3). Gyrus herniation can lead to a growing skull fracture, also known as a leptomeningeal cyst. These fractures occur in young children. As the brain, meninges, and cerebrospinal fluid herniate, they exert pressure on the surrounding skull, causing the fracture to 'grow'.

An unfortunate elderly person with hemorrhagic transformation of a temporoparietal ischemic #stroke likely due to anti-coagulant use. Image 1 was taken at 2 hours after onset of neuro deficits (confusion, slurred speech, progressing left-sided weakness). Image 2 at t+7hr. Image 3, 4 and 5 at t+19 hours show new infarcts in aca, mca, pca territories, #uncal-herniation compressing midbrain. There is no intraventricular extension of the hemorrhage. What is the patient's approximate mortality?

Herniation

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