Brain Herniation: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Brain Herniation?
A neurosurgeon, a doctor who operates on the brain and spine, treats brain herniation, often with a neurologist, a doctor who treats brain and nerve diseases. Care happens in a hospital emergency setting. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is Brain Herniation?
Brain herniation is the shifting of brain tissue from one space in the skull to another through folds and openings. It happens when something inside the skull builds up pressure that pushes the brain tissue. Brain herniation is a medical emergency. Without treatment, death is likely.
Symptoms
Symptoms come from rising pressure inside the skull. They may include:
- Severe headache.
- Weakness or numbness.
- Behavior changes.
- Vomiting and seizures.
- Loss of consciousness or coma, which means being unable to wake up.
- Wide, dilated pupils and no movement in one or both eyes.
- Loss of brainstem reflexes, such as blinking, gagging, and pupils reacting to light.
- Irregular or slow pulse, and high blood pressure.
- Cardiac arrest, which means no pulse, or respiratory arrest, which means no breathing.
Causes and who gets it
Most often, brain swelling or bleeding from a head injury, stroke, or brain tumor raises the pressure. Other causes include:
- Bleeding in the brain, called hemorrhage.
- A brain abscess, a collection of pus from an infection.
- Encephalitis or meningitis, which are infections that inflame the brain or its covering.
- Hydrocephalus, a buildup of fluid inside the skull.
- Strokes that cause brain swelling.
- Swelling after radiation therapy.
- A defect in brain structure, such as Arnold-Chiari malformation.
- Swelling due to loss of oxygen to the brain.
How doctors diagnose it
A brain and nervous system exam shows changes in alertness. Depending on how severe it is, reflexes and nerve functions may be affected. Tests may include a CT scan or MRI scan of the head. An MRI or CT scan of the head can usually find the cause of the pressure and confirm the diagnosis. An X-ray of the skull and neck may also be done. Blood tests are used if an abscess or a bleeding disorder is suspected.
Treatment
The goal of treatment is to save the person's life. The medical team treats the swelling and pressure in the brain. Treatment may involve:
- Placing a drain into the brain to remove cerebrospinal fluid, the fluid around the brain.
- Medicines to reduce swelling, such as mannitol, saline, or other diuretics. Diuretics help the body get rid of extra fluid.
- Placing a tube in the airway and increasing the breathing rate to lower carbon dioxide levels in the blood.
- Removing blood or blood clots that are raising pressure inside the skull.
- Removing part of the skull to give the brain more room.
When to see a doctor
Call 911 or the local emergency number, or take the person to a hospital emergency room, if they develop decreased alertness or other symptoms, especially after a head injury or if the person has a brain tumor or blood vessel problem. Brain herniation is a medical emergency.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Primary care providers may sometimes spot early symptoms of rising pressure in the skull, such as headache, seizures, or other nervous system problems.
Common questions
Is brain herniation deadly?
It can be. Without treatment, death is likely. Damage to the parts of the brain that control breathing and blood flow can rapidly lead to death or brain death. The outlook depends on where in the brain the herniation occurs.
Can brain herniation be prevented?
Prompt treatment of increased pressure inside the skull may reduce the risk for brain herniation. Protecting the head during contact sports, bike riding, and similar activities also lowers the risk of the injuries that can lead to it.
What are the long-term effects?
People who have a brain herniation usually have a serious brain injury. Complications may include brain death or permanent and significant neurologic problems, which are lasting problems with brain and nerve function.
Why does pressure in the skull push the brain?
Brain herniation occurs when something inside the skull produces pressure that moves brain tissue. The pressure pushes the tissue through folds and openings in the skull. Most often this comes from brain swelling or bleeding.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
