What Are the Different Types of Brain Herniation?

You may have heard the term “brain herniation” after a traumatic injury. It’s not always explained clearly. And when it is, the words doctors use can be hard to follow.

If you’re trying to make sense of the diagnosis, especially what type of herniation occurred and how it may affect recovery, this blog post can help.

We’ll explain the main types of brain herniation, how they develop, and the complications they can lead to after a serious brain injury.

To get more information and arrange a free case review, call Brain Injury Law Center at (757) 244-7000 or contact us online.

What Is a Brain Herniation?

When the brain swells after trauma, the pressure inside the skull can build quickly. With nowhere else to go, the brain may shift out of place, pressing into areas it shouldn’t. This is called herniation.

It’s a life-threatening condition that can affect breathing, movement, memory, and more.

Common causes of brain herniation include:

• High-speed car, truck, or motorcycle collisions;
• Slip and fall accidents on wet, icy, or uneven surfaces;
• Direct blows from sports, assaults, or falling objects; and
• Missed imaging or other medical treatment delays that allow pressure to build.

No matter the cause, brain herniation is always an emergency. And if negligence played a role, you may have a legal case.

Understanding the 6 Brain Herniation Types

When pressure builds up in the skull, the brain can get pushed into spaces it’s not supposed to be. Where that shift happens inside the head determines the type of herniation and the kind of damage that can result. 

Let’s take a closer look at the different types of brain herniation and what each one can lead to.

1. Subfalcine Herniation

The brain shifts from one side to the other, slipping beneath a structure called the falx.

This is one of the most common brain herniation types and often happens after a traumatic brain injury. It can reduce blood flow to critical areas, leading to weakness, especially in the legs.

2. Uncal Herniation

A section of the brain near the temple is pushed inward toward the center of the head, pressing on nerves and deeper brain structures. One early warning sign is a dilated pupil that doesn’t respond to light. As pressure spreads, it can affect breathing, awareness, and even heart rate, making this a medical emergency.

3. Central Herniation

The brain moves downward through the center of the skull, usually when swelling affects both sides. This type can cause abrupt changes in alertness, unusual muscle responses, or abnormal breathing patterns. It’s usually a sign of severe, widespread brain injury.

4. Tonsillar Herniation

The lower part of the brain, near the back of the head, is forced downward toward the spinal canal. Because this area controls breathing and heart rate, tonsillar herniation can quickly become life-threatening if not treated immediately.

5. Upward Herniation

Instead of pressure pushing down, it builds near the base of the skull and pushes tissue upward. Though less common, it can block critical blood flow and cause rapid changes in consciousness. It’s generally the result of swelling or a bleed in the back part of the brain.

6. Transcalvarial Herniation

When an injury leaves an opening in the skull, brain tissue can begin to push outward through that weakened area. This external bulging increases the risk of further damage, particularly if blood vessels or brain matter are compressed in the process.

All types of brain herniation are a medical emergency. These injuries often follow trauma, like a car crash, motorcycle collision, or fall, that could have been avoided if someone else had taken proper care.

When a brain injury changes your loved one’s life, the Brain Injury Law Center can step in. Call (757) 244-7000 or message us online to speak with an experienced brain injury attorney in a free, no-obligation consultation.

Brain Herniation Signs and Symptoms After a Head Injury

Certain symptoms point to rising pressure inside the skull after a serious head injury. Here’s what to watch for:

• Sudden loss of alertness: A person who was speaking moments ago may become drowsy, confused, or stop responding entirely. This rapid shift is one of the clearest signs that pressure is building inside the skull.
• Unequal pupils: One pupil may appear larger than the other or stop reacting to light. Eye changes like these are strong indicators that part of the brain is being pushed out of position.
• Weakness or paralysis on one side. Injuries that affect movement often begin with slight weakness in one arm or leg. That weakness can quickly progress to complete paralysis if the pressure isn’t released.
• Abnormal breathing or heart rate. Shallow, slow, or irregular breathing can signal that the brainstem is under stress. Changes in heart rate follow shortly after—both are considered late and dangerous signs of herniation.
• Seizures. Twitching, convulsions, or unresponsive staring may occur at any stage. After a head injury, any seizure should be treated as an emergency that could involve rising intracranial pressure.
• Intense headache with vomiting. Nausea and headache that come on suddenly without fever or illness may indicate swelling or bleeding inside the brain.

When any of these brain herniation signs and symptoms appear, see a doctor immediately. Prompt treatment to relieve pressure offers the best chance to protect brain function and limit lasting damage.

What Is Brain Herniation Treatment Like?

Treatment for brain herniation starts with one goal: take the pressure off the brain fast. Doctors may use a mix of emergency steps, including:

• Medication to bring swelling down;
• A drain to release built-up fluid;
• Surgery to remove a clot, stop bleeding, or relieve pressure from a mass;
• A ventilator to stabilize breathing; and
• In some cases, part of the skull is removed to give the brain space.

Brain herniation treatment and recovery look different for every patient. Some individuals regain most of their function with rehabilitation, while others may experience permanent cognitive, motor, or sensory deficits. Long-term therapy may involve:

• Speech and language therapy for communication difficulties,
• Occupational therapy for daily life activities,
• Physical therapy to regain movement and coordination, and
• Support for mental health, including depression, PTSD, or emotional changes caused by the injury.

These medical needs often translate into significant costs, both physically, emotionally, and financially. In many cases, brain herniation results from someone else’s negligence, whether through a car accident, medical error, or unsafe property condition. When that happens, you deserve more than just recovery—you deserve justice.

Talk With a Top-Rated Brain Injury Lawyer Today

Brain herniation often follows a traumatic event that never should have happened. Whether the injury was caused by a crash, fall, or delayed diagnosis, the outcome can be life-altering, and someone should be held accountable.

At Brain Injury Law Center, we’ve represented clients with some of the most serious brain injuries in Virginia and nationwide. Our attorneys have recovered over $1 billion for those whose lives were permanently changed by someone else’s actions. We work to secure the resources our clients need for long-term care, rehabilitation, and support. 

Call (757) 244-7000 or contact us online for a free case review.