Incidental Idiopathic Left Uncal Herniation: A Case Study and Literature Review

Background: Idiopathic uncal herniation in patients is a very rare phenomenon, with only two cases documented in the English literature. Case Report: The authors report a previously fit and well patient in their 60’s who presented with a 12-month history of headaches and vomiting. On clinical examination, there was no focal neurology, and all cranial nerves were intact. MRI revealed an incidental finding of left uncal herniation, which was likely developmental. The patient was discharged from neurosurgery, with a plan for the GP to refer to neurology for the headaches and vomiting. Discussion: A correct diagnosis of idiopathic brain herniation is important to avoid unnecessary invasive procedures. Herniation should be differentiated from other pathologies, including tumours, encephaloceles, and dural venous sinus thrombosis. Conclusion: Incidental findings of uncal herniation remain an extreme rarity. Future research is required to guide management and prognostication in this select group of patients.