Time to master mass effect!! Four main types of herniation from mass effect: Subfalcine: Brain herniates under the flax. See as midline shift in axial CT slices Transtentorial: Temporal lobes herniated across the tentorium into the posterior fossa & cause mass effect upon the brainstem. This is seen as... effacement of basilar cisterns on axial CT slices Transcranial: Occurs in the setting of a defect-usually to relieve mass effect. Brain herniates into the defect, usually relieving mass effect intracranially Tonsillar herniation: Mass effect in the posterior fossa causes the brainstem to herniate downward through the foramen magnum. This can eventually compress the brainstem. Now you know the different types of brain herniations and what they look like! Hopefully, now you will never have to debate when the brain herniates!!show more

Lea Alhilali, MD

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