UPWARD TRANSETORIAL HERNIATION

Abstract

Upward transtentorial herniation describes the displacement of the posterior fossa contents, through
the tentorium cerebelli, to the supratentorial cranial compartment. It is the least understood type of brain
herniation. The purpose of this review is to analyze the literature regarding this pathological entity. A
posterior fossa space-occupying lesion is usually its cause. Upward transtentorial herniation’s clinical pres-
entation includes signs and symptoms of brainstem compression and its potential displacement. Disturbed
level of consciousness and abnormal opthalmological signs are characteristic findings. Brain’s computed
tomography is the imaging modality of choice in order to establish the diagnosis. It also helps to reveal the
underlying pathology responsible for the herniation. Emergency surgical decompression of the posterior
fossa can save patients’ lives. Mortality is high and depends on the clinical presentation’s severity. In clini-
cal practice, diagnosis of upward transtentorial herniation and management of the sufferers constitutes a
medical challenge. Close patients’ observation with frequent neurological examination, intracranial pres-
sure measurement (where indicated depending on the underlying pathology) and urgent neuroimaging,
help in prompt diagnosis and surgical intervention without delay. Thus, non-reversible neurological dam-
age of the affected patients could be avoided.