Analysis of Complications of Subfalcine Herniation on CT and MRI and Estimation of their Incidence


Authors : Dr. Ritika Khurana; Dr. Aditi Mathur; Dr. Manoj Mathur; Dr. Sulabh Puri; Dr. Gurpreet Singh Sandhu; Dr. Sanjay Goyal; Dr. Mehreet Kaur Chahal

Volume/Issue : Volume 9 - 2024, Issue 9 - September

Google Scholar : https://tinyurl.com/t7vybajf

Scribd : https://tinyurl.com/385rtt39

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP1019

PlumX Metrics

Semantic Scholar

ResearchGate

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background Subfalcine herniation is the most common type of intracranial herniation. It occurs when brain tissue is pushed under the falx cerebri. Focal necrosis of the cingulate gyrus can occur from direct compression against the falx cerebri. An MLS less than 5 mm suggests a positive outcome, while a shift greater than 15 mm indicates a worse outcome. Prognosis for cerebral herniation depends on factors like the cause, intracranial pressure, cerebral ischemia, and affected brain structures.  Objectives To identify and estimate the incidence of complications from subfalcine herniation on CT and MRI. Materials & Methods The study was conducted prospectively in the Department of Radiodiagnosis, Rajindra hospital, Government Medical College, Patiala on 36 patients who were referred with clinical symptoms and signs of brain herniation due to any etiology. All the patients were subjected to MRI and CT scan. Imaging was performed using CT machine (GE Medical Systems Revolution EVO 128 slice MDCT machine for image acquisition)/ MRI scanner (Siemens 1.5T Magnetom aera MRI machine). All the results were summarized in Microsoft excel sheet and were analyzed by SPSS software.  Results The mean age of 51±19.26 years with a male preponderance (58.33% males). Hypertensive bleed and intra-axial lesion (25% patients each) were the most common pathological finding that led to subfalcine herniation. On initial assessment, 63.89% patients had GCS 9-12, 19.44% had GCS 13-15 and 16.67% had GCS 3-8. On CT scan, our study found that 22.22% patients were having MLS ≤5 mm, 30.55% patients between 6 to 10 mm, 41.67% patients between 11 to 20 mm and 5.55% patients had shift >20 mm. Subfalcine herniation led to complications like hydrocephalus (58.33%), ACA infarct (25%), Hydrocephalus with 3rd cranial nerve palsy (8.33%), Hydrocephalus with Duret hemorrhage (5.56%) and PCA infarct (2.78%).  Conclusion A weak correlation between suspected raised ICP and patient outcomes was noted. Prompt diagnosis relies on CT and MRI scans. Initial symptoms may be subtle, emphasizing the need for comprehensive evaluation and rapid imaging. Early intervention is pivotal for improving outcomes and managing complications associated with cerebral herniation.

Keywords : Subfalcine Herniation, Midline Shift, Hydrocephalus, ACA Infarct, PCA Infarct.

References :

  1. Riveros Gilardi B, Muñoz López JI, Hernández Villegas AC, Garay Mora JA, Rico Rodríguez OC, Chávez Appendini R, et al. Types of cerebral herniation and their imaging features. Radiographics. 2019 Oct;39(6):1598-610.
  2. Johnson PL, Eckard DA, Chason DP, Brecheisen MA, Batnitzky S. Imaging of acquired cerebral herniations. Neuroimaging Clinics. 2002 ;12(2):217-28.
  3. Laine FJ, Shedden AI, Dunn MM, Ghatak NR. Acquired intracranial herniations: MR imaging findings. AJR. American journal of roentgenology. 1995;165(4):967-73.
  4. Ross DA, Olsen WL, Ross AM, Andrews BT, Pitts LH. Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma. Journal of neurosurgery. 1989 ;71(4):498-502.
  5. Michaud LJ, Rivara FP, Grady MS, Reay DT. Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery. 1992;31(2):254-64.
  6. Andrews BT, Pitts LH. Functional recovery after traumatic transtentorial herniation. Neurosurgery. 1991 ;29(2):227-31.
  7. Kalita J, Misra UK, Vajpeyee A, Phadke RV, Handique A, Salwani V. Brain herniations in patients with intracerebral hemorrhage. Acta Neurol Scand. 2009;119(4):254-60.
  8. Svedung Wettervik T, Lewén A, Enblad P. Post-traumatic hydrocephalus - incidence, risk factors, treatment, and clinical outcome. Br J Neurosurg. 2022 ;36(3):400-406.
  9. Puffer RC, Yue JK, Mesley M, Billigen JB, Sharpless J, Fetzick AL et al. Long-term outcome in traumatic brain injury patients with midline shift: a secondary analysis of the Phase 3 COBRIT clinical trial. J Neurosurg. 2018 ;131(2):596-603
  10. Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig. 2019 (3):780-792.
  11. Setyopranoto I, Bayuangga HF, Panggabean AS, Alifaningdyah S, Lazuardi L, Dewi FST, et al Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia. Stroke Res Treat. 2019 ;2019
  12. Bayleyegn NS, Abafita M, Worku AT, Baye MF. Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia. Egyptian Journal of Neurosurgery. 2024 Feb 23;39(1):10.
  13. Choudhary A, Kaushik K, Bhaskar SN, Gupta LN, Sharma R, Varshney R. Correlation of initial computed tomography findings with outcomes of patients with acute subdural hematoma: a prospective study. Indian Journal of Neurotrauma. 2021 Jun;18(01):19-25.
  14. Sobti S, Goyari M, Harpanahalli R, Gupta LN, Choudhary A, Taneja A. Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional Experience. J Pediatr Neurosci. 2021 Apr-Jun;16(2):113-118.
  15. Puffer RC, Yue JK, Mesley M, Billigen JB, Sharpless J, Fetzick AL et al. Long-term outcome in traumatic brain injury patients with midline shift: a secondary analysis of the Phase 3 COBRIT clinical trial. J Neurosurg. 2018 ;131(2):596-603
  16. Kalita J, Misra UK, Vajpeyee A, Phadke RV, Handique A, Salwani V. Brain herniations in patients with intracerebral hemorrhage. Acta Neurol Scand. 2009;119(4):254-60.
  17. Mirvis SE, Wolf AL, Numaguchi Y, Corradino G, Joslyn JN. Posttraumatic cerebral infarction diagnosed by CT: prevalence, origin, and outcome. AJR Am J Roentgenol. 1990 ;154(6):1293-8.
  18. Server A, Dullerud R, Haakonsen M, Nakstad PH, Johnsen UL, Magnaes B. Post-traumatic cerebral infarction. Neuroimaging findings, etiology and outcome. Acta Radiol. 2001;42(3):254-60.
  19. Chen KH, Lee CP, Yang YH, Yang YH, Chen CM, Lu ML, et al. Incidence of hydrocephalus in traumatic brain injury: A nationwide population-based cohort study. Medicine (Baltimore). 2019 ;98(42):e17568.
  20. Owen B, Akbik O, Torbey M, Davis H, Carlson AP. Incidence and outcomes of intracerebral haemorrhage with mechanical compression hydrocephalus. Stroke Vasc Neurol. 2021;6(3):328-336.
  21. Losseff N, Adams M, Brown MM, Grieve J, Simister R. Stroke and Cerebrovascular Diseases. Neurology: A Queen Square Textbook. 2016 Aug 10:133-85.

Background Subfalcine herniation is the most common type of intracranial herniation. It occurs when brain tissue is pushed under the falx cerebri. Focal necrosis of the cingulate gyrus can occur from direct compression against the falx cerebri. An MLS less than 5 mm suggests a positive outcome, while a shift greater than 15 mm indicates a worse outcome. Prognosis for cerebral herniation depends on factors like the cause, intracranial pressure, cerebral ischemia, and affected brain structures.  Objectives To identify and estimate the incidence of complications from subfalcine herniation on CT and MRI. Materials & Methods The study was conducted prospectively in the Department of Radiodiagnosis, Rajindra hospital, Government Medical College, Patiala on 36 patients who were referred with clinical symptoms and signs of brain herniation due to any etiology. All the patients were subjected to MRI and CT scan. Imaging was performed using CT machine (GE Medical Systems Revolution EVO 128 slice MDCT machine for image acquisition)/ MRI scanner (Siemens 1.5T Magnetom aera MRI machine). All the results were summarized in Microsoft excel sheet and were analyzed by SPSS software.  Results The mean age of 51±19.26 years with a male preponderance (58.33% males). Hypertensive bleed and intra-axial lesion (25% patients each) were the most common pathological finding that led to subfalcine herniation. On initial assessment, 63.89% patients had GCS 9-12, 19.44% had GCS 13-15 and 16.67% had GCS 3-8. On CT scan, our study found that 22.22% patients were having MLS ≤5 mm, 30.55% patients between 6 to 10 mm, 41.67% patients between 11 to 20 mm and 5.55% patients had shift >20 mm. Subfalcine herniation led to complications like hydrocephalus (58.33%), ACA infarct (25%), Hydrocephalus with 3rd cranial nerve palsy (8.33%), Hydrocephalus with Duret hemorrhage (5.56%) and PCA infarct (2.78%).  Conclusion A weak correlation between suspected raised ICP and patient outcomes was noted. Prompt diagnosis relies on CT and MRI scans. Initial symptoms may be subtle, emphasizing the need for comprehensive evaluation and rapid imaging. Early intervention is pivotal for improving outcomes and managing complications associated with cerebral herniation.

Keywords : Subfalcine Herniation, Midline Shift, Hydrocephalus, ACA Infarct, PCA Infarct.

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe