Sequence of signs with progressive cerebral herniation
The idealized sequence of physical signs, with progressive cerebral herniation, is described below:
- diencephalic stage:
- confused and drowsy
- constricted pupils
- gaze palsies
- mesencephalic stage:
- unconscious
- decerebrate posturing
- dilated pupils
- hyperventilation
- pontine stage:
- unconscious
- decerebrate posturing
- constricted pupils
- irregular breathing
- medullary stage:
- unconscious
- flaccid
- loss of homeostatic control:
- increase heart rate
- decrease blood pressure
- hyperthermia
- Cheyne-Stokes breathing
- apnoea and cardiac arrest
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