here is a diagram of some of the most common types of brain herniation syndromes with subfalcine herniations brain tissue extends under the fols in the super tentorial cerebrum causing small reactive pupils and contralateral leg paralysis trans tentorial descending herniations also known as uncle herniations are the most common type caused by the medial temporal lobe pushing downward into the posterior FASA through the inzer leading to ipsilateral pupil dilation contralateral hemiparesis and cerebrate posturing trans tentorial bilateral also known as Central herniations results from downward displacement of the cerebral hemispheres and basil nuclei compressing and displacing the dlon and midbrain rostr codly through the tentorial notch this leads to medium-sized fixed pupils stuper and coma decorticate posturing cheny Stokes respirations and diabetes and citus trans tentorial ascending herniations occurs when the infratentorial m effect protrudes upwards to compress the midbrain which can present clinically with nausea vomiting and Progressive stuper tular herniations are when the cerebellar tonsils protrude below the frame and Magnum compressing the medulla and upper cervical spinal cord leading to hypertension bradicardia brynea and respiratory arrest a constellation of symptoms we often refer to as a Cushing reflex and finally there are transc calvarial herniations which are the rarest of the bunch and usually the result of P penetrating injuries to the head and skull which leave a defect or opening for herniation to occur as a result of this mechanism signs and symptoms can vary depending on whether or not the brain tissue was involved in the penetrating injury or not and also the location of the brain that is involved