Analysis of Complications of Subfalcine Herniation on CT and MRI and Estimation of their Incidence

Background Subfalcine herniation is the most common type of intracranial herniation. It occurs when brain tissue is pushed under the falx cerebri. Focal necrosis of the cingulate gyrus can occur from direct compression against the falx cerebri. An MLS less than 5 mm suggests a positive outcome, while a shift greater than 15 mm indicates a worse outcome. Prognosis for cerebral herniation depends on factors like the cause, intracranial pressure, cerebral ischemia, and affected brain structures.  Objectives To identify and estimate the incidence of complications from subfalcine herniation on CT and MRI. Materials & Methods The study was conducted prospectively in the Department of Radiodiagnosis, Rajindra hospital, Government Medical College, Patiala on 36 patients who were referred with clinical symptoms and signs of brain herniation due to any etiology. All the patients were subjected to MRI and CT scan. Imaging was performed using CT machine (GE Medical Systems Revolution EVO 128 slice MDCT machine for image acquisition)/ MRI scanner (Siemens 1.5T Magnetom aera MRI machine). All the results were summarized in Microsoft excel sheet and were analyzed by SPSS software.  Results The mean age of 51±19.26 years with a male preponderance (58.33% males). Hypertensive bleed and intra-axial lesion (25% patients each) were the most common pathological finding that led to subfalcine herniation. On initial assessment, 63.89% patients had GCS 9-12, 19.44% had GCS 13-15 and 16.67% had GCS 3-8. On CT scan, our study found that 22.22% patients were having MLS ≤5 mm, 30.55% patients between 6 to 10 mm, 41.67% patients between 11 to 20 mm and 5.55% patients had shift >20 mm. Subfalcine herniation led to complications like hydrocephalus (58.33%), ACA infarct (25%), Hydrocephalus with 3rd cranial nerve palsy (8.33%), Hydrocephalus with Duret hemorrhage (5.56%) and PCA infarct (2.78%).  Conclusion A weak correlation between suspected raised ICP and patient outcomes was noted. Prompt diagnosis relies on CT and MRI scans. Initial symptoms may be subtle, emphasizing the need for comprehensive evaluation and rapid imaging. Early intervention is pivotal for improving outcomes and managing complications associated with cerebral herniation.