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LETTER TO EDITOR
Year : 2010  |  Volume : 58  |  Issue : 6  |  Page : 953--954

Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note

Laszlo Novak1, Istvan Pataki2, Andrea Nagy2, Ervin Berenyi3,  
1 Department of Neurosurgery,University of Debrecen, Medical and Health Sciences Center, Hungary
2 Department of Pediatrics, University of Debrecen, Medical and Health Sciences Center, Hungary
3 Department of Biomedical Laboratory and Imaging Science, University of Debrecen, Medical and Health Sciences Center, Hungary

Correspondence Address:
Laszlo Novak
Department of Neurosurgery,University of Debrecen, Medical and Health Sciences Center
Hungary




How to cite this article:
Novak L, Pataki I, Nagy A, Berenyi E. Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note.Neurol India 2010;58:953-954


How to cite this URL:
Novak L, Pataki I, Nagy A, Berenyi E. Bilateral transtentorial herniation and isolated fourth ventricle: A scientific note. Neurol India [serial online] 2010 [cited 2020 Jul 11 ];58:953-954
Available from: http://www.neurologyindia.com/text.asp?2010/58/6/953/73758


Full Text

Sir,

In transtentorial herniation, downward shift of the uncus occurs through the tentorial incisura and often leads to death. The treatment is decompression. [1] Bilateral uncal herniation is typically seen in brain death. [2] Transtentorial herniation can cause occipital infarcts resulting in visual loss. [3] A 9-year-old boy was born at 29 th week of gestation as he had placental insufficiency. He needed resuscitation and suffered intraventricular hemorrhage in the early postnatal period. After ventricular drainage, he underwent ventriculo-peritoneal shunt implantation-initially, supratentorially; and later, infratentorially- because of the isolated and enlarged fourth ventricle. Altogether, he had undergone 33 interventions for various obstructive and infective complications. At this visit, he was ambulant with retarded cognitive functions (developmental age, 3-4 years). He used to get recurrent partial complex seizures of temporal semiology. Cranial magnetic resonance imaging (MRI) scan revealed bilateral transtentorial herniation [Figure 1] with brainstem compression [Figure 2]. Herniated unci resulted in pressure gradient causing the isolation of the infratentorial subarachnoid spaces. [4] Possibly, he could survive the bilateral transtentorial herniation as there was no ischemic brainstem injury. [4] To the best of our knowledge, this is the first demonstration of such phenomenon in a living person.{Figure 1}{Figure 2}

References

1Mori K, Ishimaru S, Maeda M. Unco-parahippocampectomy for direct surgical treatment of downward transtentorial herniation. Acta Neurochir (Wien) 1998;140:1239-44.
2Lovblad KO, Bassetti C. Diffusion-weighted magnetic resonance imaging in brain death. Stroke 2000;31:539-42.
3Tanaka R, Miyasaka Y, Yada K, Mukuno K. Bilateral homonymous hemianopsia due to tentorial herniation, with sparing of central vision: Case report. Neurosurgery 1992;31:787-90.
4Hussain SI, Cordero-Tumangday C, Goldenberg FD, Wollman R, Frank JI, Rosengart AJ. Brainstem ischemia in acute herniation syndrome. J Neurol Sci 2008;268:190-2.