ICP and Brain herniation Flashcards
___________ states that: The sum of volumes of intracranial blood, CSF, and brain within the cranium is constant, which means that an increase in one component volume will be compensated for by a decrease in other(s)
Monro-Kellie principle
Explain subfalcine herniation
Mass effect due to affection of the ipsilateral frontal, parietal, or temporal lobes → medial displacement of the cingulate gyrus → herniation under the falx cerebri → compression of:
Anterior cerebral artery branches (specifically the pericallosal artery) → contralateral hemiparesis (predominantly lower limbs)
Contralateral hemisphere → obstruction of the foramen of Monro → hydrocephalus
Subdural hematoma with subfalcine herniation
Uncal herniation usually compress what nerve that control eye movements?
CNIII
mass effect caused by a supratentorial lesion → medial and downward displacement of the uncus at the tentorial incisure
Which of the following is a common cause of increased intracranial pressure (ICP)?
a) Hypotension
b) Hyperventilation
c) Cerebral edema
d) Increased blood glucose levels
c) Cerebral edema
What is the earliest sign of increased ICP?
a) Papilledema
b) Altered mental status
c) Headache
d) Seizures
c) Headache
Which of the following types of herniation involves downward displacement of the cerebellar tonsils through the foramen magnum?
a) Transtentorial herniation
b) Uncal herniation
c) Tonsillar herniation
d) Subfalcine herniation
c) Tonsillar herniation
What is the most common cause of brain herniation?
a) Traumatic brain injury
b) Cerebral infarction
c) Brain tumor
d) Hydrocephalus
C) Brain tumour
Which of the following signs is associated with uncal herniation?
a) Dilated and non-reactive pupils
b) Decerebrate posturing
c) Decorticate posturing
d) Cushing’s triad
C
Cushing’s triad is characterized by which of the following signs?
a) Hypotension, bradycardia, and irregular respirations
b) Hypertension, tachycardia, and hyperthermia
c) Hypertension, bradycardia, and Cheyne-Stokes respirations
d) Hypotension, tachycardia, and Kussmaul respirations
Answer:
c) Hypertension, bradycardia, and Cheyne-Stokes respirations
Which imaging modality is most commonly used to assess ICP and brain herniation?
a) Computed tomography (CT) scan
b) Magnetic resonance imaging (MRI)
c) Positron emission tomography (PET) scan
d) Electroencephalogram (EEG)
a) Computed tomography (CT) scan
What is the treatment of choice for elevated ICP and brain herniation?
a) Administration of diuretics
b) Ventricular shunt placement
c) Administration of corticosteroids
d) Surgical decompression
d) Surgical decompression
Which of the following is a potential complication of brain herniation?
a) Increased cerebral perfusion
b) Cerebral vasospasm
c) Brainstem compression
d) Cerebral aneurysm rupture
c) Brainstem compression
Which of the following measures can help reduce ICP in a patient with brain herniation?
a) Hyperoxygenation
b) Hyperventilation
c) Trendelenburg position
d) Fluid bolus administration
a) Hyperoxygenation
Which of the following is a non-invasive method used to monitor intracranial pressure (ICP)?
a) Lumbar puncture
b) Transcranial Doppler ultrasound
c) Electroencephalogram (EEG)
d) Arterial blood gas (ABG) analysis
b) Transcranial Doppler ultrasound
Which type of brain herniation involves the displacement of brain tissue under the falx cerebri?
a) Uncal herniation
b) Subfalcine herniation
c) Tonsillar herniation
d) Transcalvarial herniation
b) Subfalcine herniation
Which of the following is a clinical feature of uncal herniation?
a) Dilated and fixed pupils
b) Ipsilateral hemiparesis
c) Decerebrate posturing
d) Loss of consciousness
What is the mechanism behind the development of cerebral edema in cases of increased ICP?
a) Increased blood flow to the brain
b) Disruption of the blood-brain barrier
c) Decreased cerebrospinal fluid production
d) Impaired autoregulation of cerebral blood flow
B
Which of the following is a risk factor for the development of brain herniation?
a) Hypotension
b) Hypercapnia
c) Hypoglycemia
d) Hyponatremia
B
Hypercapnia can contribute to the development of brain herniation due to its effects on cerebral blood vessels. When the levels of CO2 in the blood rise, it leads to vasodilation of cerebral blood vessels. This vasodilation can increase cerebral blood volume and subsequently raise ICP.
Which cranial nerve is most commonly affected in cases of brainstem compression due to brain herniation?
a) Cranial nerve III (oculomotor nerve)
b) Cranial nerve V (trigeminal nerve)
c) Cranial nerve IX (glossopharyngeal nerve)
d) Cranial nerve XII (hypoglossal nerve)
A
What is the primary goal of medical management in patients with elevated ICP?
a) Reducing cerebral blood flow
b) Controlling seizures
c) Promoting brain oxygenation
d) Administering analgesics for pain relief
c) Promoting brain oxygenation
Which imaging modality is considered the gold standard for diagnosing brain herniation?
a) Magnetic resonance imaging (MRI)
b) Computed tomography (CT) scan
c) Positron emission tomography (PET) scan
d) Single-photon emission computed tomography (SPECT)
A
What is the treatment of choice for cerebral herniation that involves removing a portion of the skull to relieve pressure?
a) Craniotomy
b) Lumbar puncture
c) Ventriculostomy
d) Cerebral angiography
A
