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 patient'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 fluid
Corticosteroids, such as dexamethasone, especially if there is a brain tumor, to reduce swelling
Medications 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
The outlook varies and depends on where in the brain the herniation occurrs. Without treatment, death is likely.
A brain herniation often causes a massive stroke. There can be damage to parts of the brain that control breathing and blood flow. This can rapidly lead to death or brain death.
Permanent and significant neurologic problems
Calling your health care provider
Call your local emergency number (such as 911) or take the patient to a hospital emergency room if he or she develops 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.
Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.