Table 3

Herniation sydromes

Uncal Unilateral fixed dilated pupil
Unilateral ptosis
Minimal deviation of eyes on oculocephalic/oculovestibular testing
Hemiparesis
Diencephalic Small or midpoint pupils reactive to light
Full deviation of eyes on oculocephalic/oculovestibular testing
Flexor response to pain and/or decorticate posturing
Hypertonia and/or hypereflexia with extensor plantars
Cheyne–Stokes respiration
Midbrain/upper pontine Midpoint pupils, fixed to light
Minimal deviation of eyes on oculocephalic/oculovestibular testing
Extensor response to pain and/or decerebrate posturing
Hyperventilation
Lower pontine Midpoint pupils, fixed to light
No response on oculocephalic/oculovestibular testing
No response to pain or flexion of legs only
Flaccidity with extensor plantars
Shallow or ataxic respiration
Medullary Pupils dilated and fixed to light
Slow, irregular, or gasping respiration
Respiratory arrest with adequate cardiac output
  • Bold refers to clinical signs of potentially reversible cerebral herniation.