Brain Code and Coma Recovery: Aggressive Management of Cerebral Herniation

Atul A. Kalanuria; Romergryko G. Geocadin; Hans A. Püttgen

doi:10.1055/s-0033-1348961

Seminars in Neurology, Table of Contents

Semin Neurol 2013; 33(02): 133-141
DOI: 10.1055/s-0033-1348961

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Brain Code and Coma Recovery: Aggressive Management of Cerebral Herniation

Atul A. Kalanuria

¹Division of Neurosciences Critical Care Medicine, Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

²Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Romergryko G. Geocadin

¹Division of Neurosciences Critical Care Medicine, Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

²Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

³Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Hans A. Püttgen

¹Division of Neurosciences Critical Care Medicine, Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

²Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

› Author Affiliations

Abstract

Cerebral herniation occurs due to lateral or vertical shifts in brain tissue as a complication of an intra- or extra-axial nervous system pathology. Midline shift of midline brain structures has been independently associated with poor outcome in a variety of neurologic injuries. Herniation may present as a subacute phenomenon constituting mild and progressive alteration of consciousness or as a hyperacute scenario wherein there is rapid decompensation of intracranial compliance. If left uncontrolled, cerebral herniation will lead to destruction of arousal mechanisms and result in a comatose state. A protocol-based approach for the management of herniation has the potential to minimize or reverse these shifts and in conjunction with clinical examination, radiologic data and neuromonitoring techniques offer the option of preventing a second catastrophe. In this article, the authors discuss the mechanisms that lead to coma in brain-herniating patients and the treatment choices that have been successfully used in this patient population.

Keywords

acute - cerebral - herniation - coma - management

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References

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