Massive Intracranial Hemorrhage with Subsequent Subfalcine and Transtentorial Herniation: A Case Study




Hubbard, Daniel
Garcia, Laura
Nguyen, Sarah
Ozguc, Fatma
Steinberg, Spencer
Flores, Lesley
Fisher, Cara


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Background: Brain herniation is a progression of pathology due to increased intracranial pressure creating a mass effect. The mass effect created by a large intracranial hemorrhage on one side of the brain often leads to a subfalcine herniation. Subfalcine herniation is a common type of herniation, characterized by displacement of the brain beneath the inferior border of the falx cerebri dural infolding. As the mass effect increases, it can cause further herniations in the brain. In this case study, the posterior brain cavity is affected by a transtentorial herniation which causes compression of the brainstem and the cerebellum. This mass effect can lead to a variety of symptoms including headache, nausea, vomiting, and altered mental status. This case study is a classic presentation of a massive intracranial hemorrhage with resultant cerebral and cerebellar shifts due to mass effect. Case Information: This case report presents a subfalcine herniation secondary to intracranial hemorrhage found during routine dissection in a 63-year-old male cadaver. Cause of death for the subject was listed as: Intracranial hemorrhage with subfalcine herniation, coagulopathy, acute liver failure, ischemia, congestive heart failure, and chronic obstructive pulmonary disease. Photographs of the brain and cranial cavity were obtained as well as cerebellar shift measurements along the transverse axis. Conclusion: This case highlights the pathologies that can develop in severe cases of intracranial hemorrhage, and it emphasizes the comorbidities that may have affected the prognosis as well as the progression of the disease. Consideration of presenting symptoms can be crucial in identifying possible affected areas of the brain at the time of patient presentation. Due to the lack of patient history, we do not have a clear idea of the chronology of the disease. However, there are factors observed during dissection that allow us to concoct a plausible progression of the disease.