Neuroanatomy of Coma

• Plum & Posner: Diagnosis of Stupor and Coma

• David A. Shrier, Dean K. Shibata, Henry Z. Wang, Yuji Numaguchi and James M. Powers: Central Brain Herniation Secondary to JuvenileDiabetic Ketoacidosis. American Journal of Neuroradiology 20:1885-1888 (11 1999) (http://www.ajnr.org/cgi/content/full/20/10/1885)

• Nguyen JP, Djindjian M, Brugieres P, Badiane S, Melon E, Poirier J.;Anatomy-computerized tomography correlations in transtentorial brain herniation. J Neuroradiol. 1989;16(3):181-96.  (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2635214&dopt=Abstract)

• Microanatomy of neural membranes: pumps, channels, mitochondria, etc
• Tentorial notch; incisural edge of tentorium
• Perimesencephalic (interpeduncular, quadrigeminal, ambient, and crural) and suprasellar cisterns
• Uncus and parahippocampal gyrus
• Third nerve
• Tectum
• Aqueduct
• Territories supplied by the anterior choroidal, posterior cerebral, thalamoperforate, and superior cerebellar  arteries and hypothalamo-hypophyseal portal vessels
• Duret's hemorrhages in pons/midbrain
• Culmen cerebelli
• Pontomesencephalic reticular formation
• Thalamic nuclei: rostral intralaminar,midline thalamic nuclei,ventral medial nucleus
• Hypothalamus
• Falx cerebri
• Anterior cerebral artery
• Cingulate gyrus
• Foramen magnum
• Cerebellar tonsils
• Pontine and medullary respiratory and cardiac centres

• Draw the pathologic anatomy of herniation syndromes
• List the sequence of clinical events in herniation syndromes and correlate each sign and symptom with the anatomy of coma

• What are the 3 types of herniation syndrome that involve the tentorial hiatus?
• Where might infarctions occur in each type of herniation syndrome?