THE SYNDROMES OF THE TENTORIAL NOTCH

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Abstract
The normal anatomy of the incisure of the tentorium and the structures related to it are described so that the distortions produced by transtentorial herniation may be understood. The pathological anatomy of the tissue compromising the notch, the compressed and distorted mesencephalon and the occipital lobe made ischemic by compression of or kinking of the posterior cerebral artery, emphasizes the role of vascular disturbances in this condition. The ethereal clinical manifestations of chronic tentorial herniations make it almost impossible to diagnose the condition on clinical grounds. The striking phenomena associated with acute herniations[long dash]progressive coma, pupillary signs, hemiplegia, and decerebrate rigidity[long dash]constitute a classical and easily recognized picture. The limitations and risks of the diagnostic tests[long dash]electroencephalography, angiography and pneumoencephalography[long dash]in the presence of a transtentorial herniation, must be recognized and the least serious, which will give the desired localizing information, should be selected.