Brain Herniation and Intracranial Hypertension

Neurol Clin. 2021 May;39(2):293-318. doi: 10.1016/j.ncl.2021.02.005. Epub 2021 Mar 31.


This article introduces the basic concepts of intracranial physiology and pressure dynamics. It also includes discussion of signs and symptoms and examination and radiographic findings of patients with acute cerebral herniation as a result of increased as well as decreased intracranial pressure. Current best practices regarding medical and surgical treatments and approaches to management of intracranial hypertension as well as future directions are reviewed. Lastly, there is discussion of some of the implications of critical medical illness (sepsis, liver failure, and renal failure) and treatments thereof on causation or worsening of cerebral edema, intracranial hypertension, and cerebral herniation.

Keywords: Cerebral herniation; Dialysis disequilibrium syndrome; Hepatic encephalopathy; Herniation syndromes; Intracranial hypertension; Intracranial pressure.

Publication types

  • Review

MeSH terms

  • Encephalocele* / diagnosis
  • Encephalocele* / etiology
  • Encephalocele* / pathology
  • Humans
  • Intracranial Hypertension* / complications
  • Intracranial Hypertension* / diagnosis
  • Intracranial Hypertension* / pathology