CT scan shows obliteration of the suprasellar and quadrigeminal cisterns. Later findings include infarcts and brainstem hemorrhage. View transtentorial herniation. A subdural hematoma with a midline shift is noted. There is central transtentorial and subfalcine herniation.
Conscious patients complain of neck pain and vomiting.
They may have nystagmus, pupillary dilatation, bradycardia, hypertension and respiratory depression. Early tonsillar herniation is difficult to recognize in an unconscious patient. It may not be evident on CT scan since axial views cannot see the pathology well. Clinically changes in vital signs may be the only clinical clue in an unconscious patient. A unilateral supratentorial mass or hemorrhage results in a midline shift.