The progress notes read: the cerebellar tonsil has shifted through the foramen magnum due to in-creased pressure within the posterior fossa. The nurse would identify this note as a description of _____ herniation
a. supratentorial
b. central
c. cingulated gyrus
d. infratentorial
ANS: D
In infratentorial herniation, the cerebellar tonsil shifts through the foramen magnum because of increased pressure within the posterior fossa. Supratentorial herniation involves temporal lobe and hippocampal gyrus shifting from the middle fossa to posterior fossa. Central herniation is a type of supratentorial herniation and is the straight downward shift of the diencephalon through the tentorial notch. Gyrus herniation occurs when the cingulate gyrus shifts under the falx cerebri. Little is known about its clinical manifestations.
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