Raised intracranial pressure within the rigid cranial vault can lead to brain herniation and may be associated with anatomically patterned territorial infarction. However, the relationship between staged brain displacement and regional arterial compromise remains incompletely integrated with the underlying neuroanatomy. We therefore propose an anatomy-based framework centred on the anterior and posterior cerebral artery that links the arterial morphology, regional anatomical variations and stage-dependent displacement in subfalcine and uncal herniation. This framework may help clinicians anticipate herniation-related ischaemic patterns on imaging and provides a practical model for computed tomography interpretation and early recognition of vascular compromise.