What are the clinical signs of impending transtentorial herniation?

Ipsilateral pupil dilation (CN III compression), deteriorating consciousness, Cushing triad (hypertension, bradycardia, irregular respiration), contralateral hemiplegia from corticospinal tract compression, and decerebrate posturing indicate impending uncal herniation.

What immediate interventions are indicated for brain herniation?

Head of bed elevation to 30°, mannitol 0.25–1g/kg IV, hyperventilation to PaCO2 30–35mmHg for bridge, emergency CT, and urgent neurosurgical consultation. Hypertonic saline (3% or 23.4%) is an alternative to mannitol.

Brain Herniation Risk Score

Assess imminent risk of transtentorial or tonsillar brain herniation based on clinical signs, ICP trends, and imaging findings.

Use the full interactive calculator below, or

Related Calculators

ICH Score

Medical

Cerebral Edema Score

Medical

CPP Calculator

Medical

Brain Herniation Risk Score

Related Calculators

Frequently Asked Questions

What are the clinical signs of impending transtentorial herniation?

What immediate interventions are indicated for brain herniation?