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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 6  |  Page : 1629-1630

Rare Case of Brain Herniation Secondary to Tentorial Hypoplasia: Be Careful While Reporting!


Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Date of Web Publication23-Dec-2021

Correspondence Address:
Dr. Manisha Jana
Department of Radiodiagnosis, Room No. 81C, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.333456

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How to cite this article:
Jain R, Jana M. Rare Case of Brain Herniation Secondary to Tentorial Hypoplasia: Be Careful While Reporting!. Neurol India 2021;69:1629-30

How to cite this URL:
Jain R, Jana M. Rare Case of Brain Herniation Secondary to Tentorial Hypoplasia: Be Careful While Reporting!. Neurol India [serial online] 2021 [cited 2022 Jan 26];69:1629-30. Available from: https://www.neurologyindia.com/text.asp?2021/69/6/1629/333456




A 25-year-old gentleman presented to the OPD with complaints of severe headache for 6 months. Neurological examination was normal. Later patient underwent CECT head. A “mass” was noted in the quadrigeminal and left superior cerebellar cistern [Figure 1]. On careful evaluation, it revealed precuneus and cuneus part of left occipital lobe herniating into posterior fossa through partially hypoplastic tentorium [Figure 1]. No other associated abnormality was noted.

Transtentorial herniation is described as displacement of brain tissue to an abnormal location through tentorium. It is usually secondary (mass effect by neoplasm etc.) than primary. The proposed mechanism for rare isolated form is abnormality in fusion of tentorium.[1] Perinatal insult or trauma during birth can also lead to it.

Undoubtedly, MRI provides superior diagnostic confidence in this regard; however, CT alone can be sufficient for diagnosis. The CT features include dural defect with the herniation of normal brain parenchyma through it. It can be located anteriorly or posteriorly with the herniation of hippocampus/parahippocampus and precuneus/cuneus gyrus[2] respectively. There should be no associated secondary cause.

Soft tissue density in this region might also mimic pathologies including extra-axial brain tumors as mentioned in one of few case reports.[3] This emphasizes the need to be aware of such condition and proper evaluation, in order to avoid raising false alarm.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tanohata K, Okoshi T, Iwasawa T. Focal hypoplasia of the tentorium with temporal lobe herniation: CT demonstration. J Comput Assist Tomogr 1991;15:863-7.  Back to cited text no. 1
    
2.
Thomaere E, Schepers S, Termote B, Vanwyck R, Souverijns G. Tentorium hypoplasia with partial occipital lobe herniation. J Belg Soc Radiol 2015;98:96.  Back to cited text no. 2
    
3.
Horowitz M, Kassam A, Levy E, Lunsford LD. Misinterpretation of parahippocampal herniation for a posterior fossa tumor: Imaging and intraoperative findings. J Neuroimaging 2002;12:78-9.  Back to cited text no. 3
    


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