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Neurology- Clinical > Brain Herniation > Flashcards

Brain Herniation Flashcards

1
Q

The intracranial space is divided into compartments by folds of what?

A

Dura mater

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2
Q

The skull is a closed box so any increase in ICP causes parts of the brain to do what?

A

Shift between compartments

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3
Q

In brain herniation, vital brain structures can get compressed against what?

A

Bone or tough dura mater

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4
Q

What are the two important meningeal folds?

A

Falx cerebri and tentorium cerebelli

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5
Q

What is the function of the falx cerebri?

A

Divides the two hemispheres of the cerebrum

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6
Q

The free edge of the falx cerebri is in close contact with what structure?

A

Corpus callosum

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7
Q

What is the function of the tentorium cerebelli?

A

Separates the cerebrum from the cerebellum

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8
Q

The free edge of the tentorium cerebelli is in close contact with which structure?

A

Brainstem

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9
Q

What are the two main types of herniation?

A

Supratenorial and infratentorial

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10
Q

What is supratentorial herniation?

A

Displacement of the cerebrum

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11
Q

What is infratentorial herniation?

A

Displacement of the cerebellum

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12
Q

What are the 4 types of supratentorial herniation?

A

Uncal, central, cingulate and transcalvarial

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13
Q

What happens in uncal herniation?

A

The medial part of the temporal lobe slops down through the tentorium and puts pressure on the brainstem (especially midbrain)

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14
Q

What are the 4 clinical features that uncal herniation could present with?

A

3rd nerve palsy, contralateral hemiparesis, reduced conscious level, macular sparing homonymous hemianopia/blindness

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15
Q

3rd nerve palsy in uncal herniation occurs as a result of compression of which structure? What does this involve?

A

Ipsilateral CNIII - causes an ipsilateral fixed, dilated pupil and down and out gaze

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16
Q

Contralateral hemiparesis in uncal herniation occurs as a result of compression of which structure?

A

Ipsilateral cerebral peduncle

17
Q

Reduced level of consciousness in uncal herniation occurs as a result of compression of what structure?

A

Reticular activating formation

18
Q

Macular sparing homonymous hemianopia/blindness in uncal herniation occur as a result of compression of which structure?

A

Ipsilateral posterior cerebral artery

19
Q

‘The diencephalon and parts of the temporal lobe slip under the free edge of the tentorium’ describes which type of herniation?

A

Central

20
Q

What functions of the diencephalon can be affected in central herniation?

A

Processing sensory information and emotions, as well as hormone production

21
Q

What are some specific clinical features of central herniation?

A

Loss of vertical upgaze, bilateral fixed and small pupils, Cushing’s triad and cardiac arrest

22
Q

Loss of vertical upgaze in central herniation occurs as a result of compression of which structure?

A

Vertical gaze centres in the midbrain

23
Q

Bilateral small and fixed pupils in central herniation occurs as a result of compression of which structure?

A

Hypothalamic sympathetic pathways

24
Q

Cushing’s triad and cardiac arrest in central herniation occurs as a result of compression of which structure?

A

Medulla and cardiorespiratory centres

25
Q

‘The medial part of the frontal lobe passes under the falx cerebri to the opposite side’ correctly describes which type of herniation?

A

Cingulate (Subfalcine)

26
Q

What is the main structure that is compressed in a cingulate herniation and what does the result in?

A

The anterior cerebral artery - ischaemic stroke causing hemiparesis

27
Q

‘The brain squeezes out of the skull at a fracture or surgical site’ correctly describes which type of brain herniation?

A

Transcalvarial

28
Q

What are the 2 types of infratentorial herniation?

A

Upward and tonsillar

29
Q

What happens in upward herniation?

A

The cerebellum is displaced upwards through a notch in the tentorium cerebelli

30
Q

What happens in tonsillar herniation?

A

The cerebellar tonsils pass through the foramen magnum and compress the lower brainstem

31
Q

What are the main earlier clinical features of tonsillar herniation?

A

Headache, neck stiffness, altered consciousness, flaccid paralysis

32
Q

What are the later clinical features of tonsillar herniation?

A

Cushing’s triad and cardiac arrest

33
Q

Cushing’s triad and cardiac arrest occur in tonsillar herniation due to compression of where?

A

Medulla and cardiorespiratory centres

Neurology- Clinical (31 decks)

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