Molding of the posterior communicating artery in downward transtentorial herniation.

Abstract

In 7 of 8 patients with severe head injuries the diagnosis of downward transtentorial herniation was made angiographically despite the lack of clinical correlation between angiographic and neurologic findings. The angiographic signs of downward transtentorial herniation are: kinking, compression, or occlusion of the posterior communicating artery or its branches across the free edge of the tentorium; or its tight conformity or molding to the posterior clinoid process with notching or compression. Delay in surgery can be avoided by angiographic diagnosis.