A brain and nervous system (neurological) exam shows changes in alertness (consciousness). Depending on the severity of the herniation and the part of the brain that is being pressed on, there will be problems with one or more brain-related reflexes and nerve functions.
Brain herniation is a medical emergency. The goal of treatment is to save the person's life.
To help reverse or prevent a brain herniation, the medical team will treat increased swelling and pressure in the brain. Treatment may involve:
Placing a drain into the brain to help remove cerebrospinal fluid (CSF)
Corticosteroids, such as dexamethasone, especially if there is a brain tumor, to reduce swelling
Medicines that remove fluid from the body, such as mannitol or other diuretics, which reduce pressure inside the skull
Placing a tube in the airway (endotracheal intubation) and increasing the breathing rate to reduce the levels of carbon dioxide (CO2) in the blood
Removing blood or blood clots if they are raising pressure inside the skull and causing herniation
Removing part of the skull to give the brain more room
People who have a brain herniation have a serious brain injury. They may already have a low chance of recovery due to the injury that caused the herniation. When herniation occurs, it further lowers the chance of recovery.
The outlook varies depending on where in the brain the herniation occurs. Without treatment, death is likely.
There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death.
Complications may include:
Permanent and significant neurologic problems
When to Contact a Medical Professional
Call your local emergency number (such as 911) or take the person to a hospital emergency room if they develop decreased alertness or other symptoms, especially if there has been a head injury or if the person has a brain tumor or blood vessel problem.
Stippler M. Trauma of the Nervous System: Craniocerebral Trauma. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 50B.
Joseph Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.