Survival following upward cerebellar herniation in a neonate: a case report

Abstract

Background: Herniation of the brain within the cranial vault is rare in newborns and carries a high mortality. Reported cases show herniation downward, through the foramen magnum. This case report uniquely describes upward herniation through the cerebellar tentorium. Case Presentation: A male infant born at 38 weeks gestation had a postnatal collapse at 17 hours. There were no spontaneous movements with hypotonia, reduced reflexes, nystagmus, and seizures. Cranial ultrasound showed diffuse changes in the posterior fossa, with acute cerebellar hematoma confirmed on MRI scan with significant mass effect, herniating the right cerebellar hemisphere in an upward direction. The baby was initially managed on a palliative care pathway but stabilized with clinical and MRI improvements. He survived to discharge and has mild neurological deficits at 14 months of age. Conclusion: Herniation can occur in an upward direction, evoking cerebellar signs like nystagmus in a neonate and it appears to be potentially survivable.