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Vol. 3 No. 1 (2026)

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September 9, 2026
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September 11, 2026

Copyright (c) 2026 Muteb Batel Nawman Alhazmi, Sami Alamlah Alanazi, Abdulaziz Moria Alanazi, Yousef Ramadan Fayyad Alenezi, Amad Lafi S. Alenezi, Naif Shaim Alanazi, Talal Nazal Alanazi, Owaed Awad Alhazmi, Naif Abdullah Obaid Alanazi, Muteab Osmair Nasser Alenazi, Majed Azmi Aldahmashi, Abdullah Aladham Alenezi, Rayan Maashi F. Alanazi

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Uncal Herniation: Early Recognition and Emergency Management by Prehospital Care Providers-An Updated Review

https://doi.org/10.64483/202631768
Muteb Batel Nawman Alhazmi
Saudi Red Crescent Authority, Saudi Arabia
Sami Alamlah Alanazi
Saudi Red Crescent Authority – Northern Borders Region, Arar, Saudi Arabia
Abdulaziz Moria Alanazi
Saudi Red Crescent Authority – Northern Borders Region, Saudi Arabia
Yousef Ramadan Fayyad Alenezi
Saudi Red Crescent Authority – Northern Borders Region, Arar, Saudi Arabia
Amad Lafi S. Alenezi
Saudi Red Crescent Authority – Northern Borders Region, Arar, Saudi Arabia
Naif Shaim Alanazi
Saudi Red Crescent Authority – Arar First Sector, Saudi Arabia
Talal Nazal Alanazi
Saudi Red Crescent Authority – Northern Borders Region, Saudi Arabia
Owaed Awad Alhazmi
Saudi Red Crescent Authority – Northern Borders Region, Arar First Sector, Saudi Arabia
Naif Abdullah Obaid Alanazi
Saudi Red Crescent Authority – Northern Borders Region, Arar First Sector, Saudi Arabia
Muteab Osmair Nasser Alenazi
Saudi Red Crescent Authority – Northern Borders Region, Arar First Sector, Saudi Arabia
Majed Azmi Aldahmashi
Saudi Red Crescent Authority – Northern Borders Region, Arar First Sector, Saudi Arabia
Abdullah Aladham Alenezi
Saudi Red Crescent Authority – Arar First Sector, Saudi Arabia
Rayan Maashi F. Alanazi
Saudi Red Crescent Authority – Northern Borders Region, Saudi Arabia

Corresponding Author(s) : Muteb Batel Nawman Alhazmi

mmkzo0003@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)

Abstract

Background: Uncal herniation is a rapidly progressive and potentially fatal neurological emergency caused by displacement of the medial temporal lobe through the tentorial notch as intracranial pressure rises. It may result from traumatic brain injury, intracranial hemorrhage, malignant cerebral edema, tumors, hydrocephalus, and other space-occupying intracranial lesions.


Aim: This article reviews the anatomical basis, causes, pathophysiology, clinical manifestations, diagnostic evaluation, treatment approaches, complications, and prognosis of uncal herniation.


Methods: A narrative review was undertaken using established neurocritical care concepts and published literature addressing transtentorial herniation, intracranial hypertension, clinical neurological assessment, neuroimaging, emergency management, and neurosurgical intervention.


Results: Uncal herniation develops when compensatory intracranial mechanisms fail and pressure gradients force the uncus against the tentorial edge. Compression of the ipsilateral oculomotor nerve can cause a dilated, poorly reactive pupil, while cerebral peduncle compression may produce hemiparesis. Progressive midbrain and brainstem involvement can lead to declining consciousness, abnormal posturing, respiratory failure, coma, and death. Urgent non-contrast computed tomography is essential for identifying hemorrhage, mass effect, cisternal compression, hydrocephalus, and midline shift. Immediate management includes airway protection, optimization of oxygenation and cerebral perfusion, osmotherapy, controlled ventilation when indicated, cerebrospinal fluid diversion in selected cases, and urgent evacuation or decompression of the causative lesion.


Conclusion: Uncal herniation requires rapid clinical recognition and coordinated emergency, critical care, radiological, and neurosurgical management. Early treatment is central to reducing mortality and limiting permanent neurological disability.

Keywords

Uncal herniation, intracranial pressure, transtentorial herniation, traumatic brain injury, anisocoria, neurocritical care, emergency management.
Alhazmi, M. B. N., Alanazi, S. A., Alanazi, A. M., Alenezi, Y. R. F., Alenezi, A. L. S., Alanazi, N. S., … Alanazi, R. M. F. (2026). Uncal Herniation: Early Recognition and Emergency Management by Prehospital Care Providers-An Updated Review. Saudi Journal of Medicine and Public Health, 3(1), 116–128. https://doi.org/10.64483/202631768
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