NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutNCBIBookshelf.AserviceoftheNationalLibraryofMedicine,NationalInstitutesofHealth.StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing;2021Jan-.StatPearls[Internet].ShowdetailsTreasureIsland(FL):StatPearlsPublishing;2021Jan-.SearchtermBrainHerniationSunilMunakomi;JoeMDas.AuthorInformationAuthorsSunilMunakomi1;JoeMDas2.Affiliations1KathmanduUniversity2BirminghamChildren'sHospital,SteelhouseLn,BirminghamB46NHLastUpdate:May8,2021.ContinuingEducationActivityBrainherniation,alsocalledbraincode,requiresearlydiagnosisandpromptmanagementinordertopreventirreversiblepathologicalcascadesthateventuallyleadtorespiratoryarrestandsubsequentdeath.Thisactivityreviewstheevaluationandmanagementofbrainherniationandhighlightstheroleoftheinterprofessionalteaminevaluatingandimprovingcareforpatientswiththiscondition.Objectives:Outlinethetypicalclinicalpresentationofapatientwithbrainherniationsyndrome.Describetherostral-caudalpatternofprogressionofeachsubtypeofbrainherniationandtheirtypicalassociatedimagingfindings.Reviewtreatmentandmanagementoptionsavailableforpatientswithbrainherniation.Explaintheimportanceofimprovingcarecoordinationamongsttheinterprofessionalteamtoupgradethe"targetguided"multimodalmanagementapproachforpatientswithbrainherniationsyndrome.Earncontinuingeducationcredits(CME/CE)onthistopic.IntroductionBrainherniationcanbelabeledas“braincode”toconnatetheemergentneedtotimelycounteractsuchdisastrousbrainprocesses.[1]Thebrainisencasedwithintheskull,anyriseinintracranialpressureislimitedtosomeextentbythecompensatorydisplacementofcerebrospinalfluid(CSF)andchangesincerebralbloodvolumeasevidentbytheMonro-Kelliedoctrine.[2]Whenitoverridesthesecompensatorymechanisms,certainpartsofthebrainstartherniatingthroughspecificforaminaformedbythefalxandthetentorialincisurawithintheskull,therebypropagatingprogressiveherniationsyndromes.Brainherniationisalife-threateningeventandneedsurgentattentio