More evidence supporting a 'brain code

摘要

The syndrome of transtentorial herniation represents a usually fatal consequence of supratentorial mass lesions. Rapidly expanding supratentorial mass lesions cause displacement of the temporal lobe medially, leading to herniation of the uncus over the edge of the tentorium cerebri with subsequent compression of the posterior cerebral artery and third nerve. The earliest manifestation is a decrease in level of consciousness accompanied by unilateral pupillary dilation (because of third nerve dysfunction). The syndrome progresses to bilateral pupillary dilation, mechanical distortion, and secondary ischemia of the brainstem due to expansion of the primary lesion and impaction of the temporal lobe in the tentorial notch. Classically transtentorial herniation is considered to be a fatal consequence of a supratentorial mass lesion. Small experimental and clinical studies have demonstrated that transtentorial herniation can be reversed with aggressive medical and surgical management, but there is little information on eventual outcomes in such patients.