Which brain herniation occurs under the falx in critically ill patients?

Cingulate herniation occurs under the falx cerebri and is characterized by the displacement of the cingulate gyrus beneath the falx due to increased intracranial pressure or other factors that lead to brain swelling. This type of herniation can happen in critically ill patients whose conditions lead to an increase in volume within the cranial cavity—most commonly due to edema or mass effect.

In this scenario, the brain tissue shifts from one compartment to another, which can compress vital structures. The cingulate gyrus is relatively fixed by the falx, and as pressure builds, it is forced to move past this anatomical barrier. This can lead to vascular compromise and displacement of other critical areas of the brain, potentially resulting in significant neurological deficits.

The other forms of brain herniation described involve different brain regions and mechanisms. Uncal herniation, for instance, typically involves the temporal lobe and affects the midbrain, while cerebellar tonsillar herniation occurs when the cerebellar tonsils move downward through the foramen magnum, affecting the brainstem. Central transtentorial herniation involves downward movement of the diencephalon and midbrain, which can compress vital centers in the brain