Brain Shift Patterns: Upward, Lateral and Downward Herniation, Its Correlation with Clinical Patterns in Acute Intracranial Pathologies and Neurosurgical Management.

Brain shift is a critical radiological indicator of intracranial mass effect, resulting from haematoma, tumour, infarction, or cerebral oedema. Depending on the direction of displacement, herniation may occur as downward transtentorial, upward (reverse transtentorial), or lateral midline shift (MLS). This study aims to classify brain shift patterns and correlate radiological findings with clinical parameters, including level of consciousness, Glasgow Coma Scale (GCS), pupillary size and reactivity, and predicted intracranial pressure (ICP). Radiological data from CT and MRI were analysed alongside clinical observations in patients with acute intracranial pathology. Downward transtentorial herniation was graded into four stages based on caudal migration of the mammillary bodies, while upward transtentorial herniation was classified into three stages reflecting progressive cerebellar and brainstem displacement. Increasing degrees of brain shift correlated with declining GCS, pupillary abnormalities, and elevated ICP. In conclusion, standardised integration of imaging-based brain shift classification with clinical assessment enables earlier recognition, optimised surgical intervention, and improved prognostication in patients with acute intracranial pathologies.