Acquired brain herniations: accounting of brain computed tomograms in a Nigerian tertiary hospital

Abstract

Background: Acquired brain herniation (ABH) is mechanical displacement of a brain tissue from its normal anatomical location into an adjacent space. Four known subtypes are sub-falcine, trans-tentorial, tonsillar and transalar herniations. ABH is life threatening, thus demands prompt diagnosis and intervention as it compresses on vital brain structures.

Objective: To evaluate brain computed tomograms (CT) for the sub-types and causes of acquired brain herniations.

Design: A retrospective cross-sectional study

Setting: Department of Radiology, University of Uyo teaching hospital, Uyo, Nigeria.

Material and methods: Three hundred and ninety-six (396) brain CT from 14^th November 2012 to 30^th July 2019 were obtained from the archives of Department of Radiology, UUTH, Uyo.

Results: 14.65% (n-58) of all patients had acquired brain herniations with age range of 12- 86 years, mean age of 50.14years and male predominance of 2.62: 1. Only two subtypes of herniations namely subfalcine (n-55, 94.83%) and transtentorial (n-3, 5.17% were observed).

The causes of ABH were trauma (n-38, 65.52%), cerebrovascular accident (CVA) (n-18, 31.03%) and intracranial tumours (n-2, 3.45%). Majority of the patients in traumatic ABH were less than 50years whereas CVA and tumour were predominant above 50. The commonest causes of traumatic ABH in descending order were subdural haematoma (39.47%), intra-cerebral haematoma (28.95%), epidural haematoma (23.68%), cerebral contusion (21.05%) and subarachnoid haematoma (10.53%).

Conclusion: The commonest aetiology and subtype of acquired brain herniations in Uyo, Nigeria are trauma and subfalcine herniation respectively. Traumatic causes are commoner in younger age with reversal to mainly cerebrovascular accident in older age.