What is Brain herniation?

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When doctors announced that former Philippine Airlines CEO Lucio “Bong” Tan jr died to “brain herniation”, many people asked what the term meant.

The son of tycoon Lucio Tan and president of PAL Holdings died Monday, 04 November 2019, after collapsing before the end of the second quarter during the Pinoy Liga Cup Finals basketball game last Saturday, 02 November 2019, at the Gatorade Hoops Center in Mandaluyong.

Medical experts said herniation occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shift within the skull from its normal position. And this requires immediate medical attention.

This type of condition is usually caused by swelling from a head injury, stroke, bleeding, or a brain tumor.

These are the signs and symptoms of having a brain herniation and this may include seizures, headache, loss of reflexes, drowsiness, difficulty concentrating, dilated pupils, high blood pressure, abnormal posturing, rigid body movements, abnormal position of the body, cardiac arrest, loss of consciousness or coma.

A brain herniation is considered as a severe emergency case. Brain herniation is the result of brain swelling and it puts pressure on brain tissue (referred to as increased intracranial pressure), pushing the tissue away from its normal position.

The most common causes of this condition include stroke, brain hemorrhage (bleeding in the brain), brain tumor, head injury leading to a subdural hematoma (when blood collects on the brain’s surface beneath the skull) or swelling (cerebral edema).

Other reasons may increase the pressure in the skull these include buildup of fluid in the brain (hydrocephalus), brain surgery, abscess (collection of pus from a bacterial or fungal infection), Chiari (a defect in brain structure malformation herniation).

Those with brain tumors and complications with the blood vessels, such as an aneurysm, are at an increased risk of brain herniation.

Furthermore, any choice of behavior or lifestyle that puts you at risk for a head injury may also increase your brain herniation risk.

Treatment with this kind of condition is intended to relieve the swelling and pressure within the brain that causes the brain to herniate from one compartment to the next.

To reduce swelling and pressure, treatment may involve:

• osmotic therapy or diuretics (medications that remove fluid from the body) to pull fluid out of the brain tissue, such as mannitol or hypertonic saline

• corticosteroids to reduce swelling

• surgery to remove a part of the skull to make more room (craniectomy) and will undergo surgery to remove a tumor, hematoma (blood clot), or abscess

• surgery to place a drain called a ventriculostomy through a hole in the skull to get rid of fluids.

Treatment will be necessary to save a person’s life. While the cause of the brain herniation is being addressed, the person being treated may also receive medications to control seizures, antibiotics to treat an abscess or to prevent infection, sedation.

In addition, a person with a brain herniation will undergo medical monitoring through tests like MRI scan, blood tests, X-ray of the skull and neck, and CT scan.

If not treated immediately and taken seriously, the movement of brain tissue can impair vital structures in the body and occur complications like permanent brain damage, respiratory or cardiac arrest, coma or can lead to death.

If you have these signs and symptoms, better to consult a doctor or neurologist to know further information about brain herniation. (Cris Figueroa/IAMIGO/CNS)

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