Uncal herniation is a common types of herniation of the innermost part of the temporal lobe, the uncus. Sliding uncal syndrome is observed in uncal herniation patient who remains fully conscious despite the herniation and pressure on the brainstem.
Cause(s) : Supratentorial mass lesion compressing the uncus against the midbrain. Oculomotor nerve is compressed against the free edge of the tentorium resulting in fixed and dilated pupil.
Symptoms : Initial complaints of a person with uncal herniation is usually headache or unilateral weakness. The symptoms of each organ worsens according to the stage of herniation.
Pupil: Ipsilateral dilated pupil, progressing to external oculomotor ophthalmoplegia. The pupil of the other eye is also affected and both pupils get fixed at the mid position and dilate widely with hypoxia.
Unlike uncal herniation, there is no change in consciousness levels or hemiparesis or motor disabilities and respiration pattern.
Diagnosis and Tests :
Magnetic resonance imaging
Eye check up for pupil dilation and reaction
Checking external ocular muscles
Diagnostic criteria for sliding uncal syndrome involves:
Presence of uncal herniation in imaging procedures
Dilated non-reactive pupil with involvement of external ocular muscles
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