Tonsillar herniation

Tonsillar herniation is a type of cerebral herniation characterised by the inferior descent of the cerebellar tonsils below the foramen magnum. Clinically the presence of tonsillar herniation is often called coning.

The terminology of caudally displaced tonsils is discussed in the article on cerebellar tonsillar ectopia.


It is a secondary sign of markedly raised intracranial pressure. Any intra-axial or extra-axial lesion (e.g. tumour, haemorrhage, stroke, abscess) exerting mass effect on the brain parenchyma can displace the posterior cranial fossa structures inferiorly. In doing so the brainstem is compressed against the clivus thereby altering the vital life-sustaining functions of the pons and medulla, such as the respiratory and cardiac centres.

Radiographic features

Tonsillar herniation is seen on CT and MRI as effacement of the CSF cisterns surrounding the brainstem and as inferior descent of the cerebellar tonsils below the level of the foramen magnum.

Obstructive supratentorial hydrocephalus may result from fourth ventricle compression. 

Article information

rID: 37113
Section: Gamuts
Synonyms or Alternate Spellings:
  • Coning
  • Tonsillar herniations

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Cases and figures

  • Figure 1: herniation types
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  • Case 1: cerebral oedema
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  • Case 2: Chiari malformation
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  • Case 3: cerebral oedema
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  • Case 4: acquired tonsillar ectopia
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