COMA-SUPRATENTORIAL ETIOLOGY

SUMMARY

1. Uncal herniation: puts pressure on the RAS and compresses CN III, causing an enlarged pupil ipsilateral to the supratentorial lesion.

2. Central herniation: injury to the thalamus results in diminished consciousness very early in its course. Later, the pupils are in mid-position and become fixed. As the herniation continues, the course begins to merge with that of uncal herniation.

3. In other words, central and uncal herniation syndromes can be differentiated early on, but, later, their courses merge.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].