Signs of Herniations

Transtentorial uncal-hippocampal herniation manifests with ipsilateral occulomotor nerve palsy, dilated pupil, nonreactive to light, and ptosis.

Central diencephalic-rostral midbrain herniation manifests with small pupils, nonreactive to light and changing to midsize, respiratory changes, and decorticate posturing.

Cerebellar tonsillar herniation, or pressure cone syndrome, manifests with rising systolic and diastolic blood pressure, bradycardia, and irregular breathing, culminating in respiratory arrest.

Brainstem hemorrhage is a terminal event manifested by coma, small nonreactive pupils, bilateral pyramidal signs, and decerebrate posturing.

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