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Related Experiment Videos

MRI demonstrates descending transtentorial herniation.

E Feldmann1, S E Gandy, R Becker

  • 1Department of Neurology, New York Hospital-Cornell Medical Center, NY.

Neurology
|May 1, 1988
PubMed
Summary

Descending cerebral transtentorial herniation (DTH) can now be visualized and quantified using MRI. This brain herniation can occur before clinical signs appear in patients with large brain tumors.

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Area of Science:

  • Neurology
  • Radiology
  • Neuroscience

Background:

  • Descending cerebral transtentorial herniation (DTH) is a critical complication of intracranial masses.
  • DTH has historically been diagnosed via clinical signs, not direct visualization.

Purpose of the Study:

  • To visualize and quantify DTH in living patients using magnetic resonance imaging (MRI).
  • To compare brainstem positioning in normal individuals versus patients with supratentorial tumors.

Main Methods:

  • Midsagittal and axial MRI scans were analyzed from 50 normal subjects and 15 patients with large supratentorial tumors.
  • Measurements included Twining's line (T), T-PMJ, T-A, and lateral shifts of the diencephalon and midbrain.

Main Results:

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  • Significant decreases in T-PMJ (p < 0.0001) and T-A (p = 0.001) were observed in patients compared to normals.
  • Lateral brainstem shifts occurred but were unpredictable in degree.
  • Anatomic DTH was present in patients, sometimes preceding neurological symptoms.

Conclusions:

  • MRI can visualize and quantify DTH in living patients.
  • DTH can manifest before the onset of specific neurological signs or altered consciousness.
  • This imaging approach aids in understanding the progression of DTH in slowly developing cerebral lesions.