Cerebellar herniation syndromes

Cerebellar herniation syndromes

What are the clinical features of the cerebellar herniation syndromes? 

Mass lesions, particularly neoplasms and hematomas, often present as nonspecific symptoms such as headache.

As they enlarge, the increased pressure causes herniation of the cerebellum.

With downward herniation, the cerebellar tonsils are pushed through the foramen magnum and compress the medulla (tonsillar herniation), causing progressive vomiting, stiff neck, skew deviation of the eyes, coma, ataxic breathing, apnea, and death if not anticipated and prevented. 

In upward herniation, the cerebellum and upper brain stem are pushed through the tentorial opening (uncal herniation), leading to progressive compression of the pons and midbrain.

The patient is usually obtunded or comatose with small pupils (reactive at first) or anisocoria.

Oculocephalic and oculovestibular responses are abnormal. Hemiparesis may progress to quadriparesis and decorticate posturing.

Sources

Baloh RW: Episodic ataxias 1 and 2. Handb Clin Neurol 103:595-602, 2012. Braik T, Evans AT, Telfer M, McDunn S: Paraneoplastic neurological syndromes: unusual presentations of cancer. A practical review. Am J Med Sci 340:301-308, 2010. Ramsewak DW, Thomas A, Patel SR, Wang A, Kilanowski S: Pictorial review of pediatric and adult primary posterior fossa masses. Neurographics [serial online] 3:70-86, 2013. Available at: http://dx.doi.org/10.3174/ng.2130057 . Accessed May 11, 2015. Kondziozka D, Lunsford LD, Flickinger JC: Acoustic neuromas. Curr Treat Options Neurol 4:157-165, 2002.

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