A method for determining tentorial herniation in closed-head injury from a quantitative estimation of cerebral trauma

Cerebral damage in 42 cases involving closed-head injury was studied post mortem. The cases were divided into those that showed tentorial herniation and those that did not on the basis of the clinical histories and examination of the intact brains at autopsy. Damage seen histologically in coronal sections through the cerebral hemispheres and brain-stem was recorded on diagrams. The area of damage was quantified by placing over the diagrams a cm2 grid. The numbers of squares with damage in, length of survival following the accident and the age of the cases were found by a ranking method to be statistically significantly different in herniated and non-herniated cases. These three parameters were used in an empirically derived expression to give an index that was statistically significantly different for herniated and non-herniated cases. The purpose of the index was to obtain an objective method of assessing the degree of tentorial herniation in brain-stem damage resulting from herniation.