Five common clinical manifestations of brain herniation

The most common symptoms of brain hernia patients are increased intracranial pressure and pupil changes. Some patients will also experience impaired consciousness and movement disorders. In severe cases, even vital signs may change.

① Increased intracranial pressure: manifested as worsening headache, frequent vomiting, and restlessness, indicating that the condition is getting worse;

② Impairment of consciousness: The patient gradually develops impaired consciousness, from drowsiness and confusion to light coma and coma, and is slow to respond to external stimuli or disappears, which is the result of involvement of the ascending activation system of the brainstem reticular formation;

③Pupil changes: Initially, the pupil of the affected side may shrink for a short period of time, but it is often difficult to detect. Later, the pupil on that side gradually dilates, and its response to light becomes slow and disappears, indicating that the parasympathetic nerve fibers in the dorsal part of the oculomotor nerve have been damaged. In the late stage, the pupils are dilated, the light reflex disappears, and the eyeballs are fixed;

④ Pyramidal tract signs: Due to compression of the cerebral peduncle on the affected side, weakness or paralysis of the contralateral limbs, increased muscle tone, hyperreflexia of the tendons, and positive pathological reflexes occur. Sometimes, the brain stem is pushed to the opposite side, causing the opposite cerebral peduncle to squeeze the free edge of the tentorium cerebelli, resulting in pyramidal tract signs on the same side of the brain herniation. Careful analysis is required to avoid errors in determining the side of the lesion.

⑤ Changes in vital signs: manifested as increased blood pressure, slow and slow pulse, deep and slow breathing, and increased body temperature. In the late stage, the vital centers gradually fail, and tidal or sighing breathing appears, the pulse is weak, and the blood pressure and body temperature drop; finally, breathing stops, and then the heart stops.