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Neurology Week 4 2018/19 > Brain herniations > Flashcards

Flashcards in Brain herniations Deck (24)
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1

What is a herniation?

Abnormal movement of an organ through an opening

2

What causes brain herniation?

Increased intracranial pressure

secondary to tumours, bleeding, hydrocephalus, infection, cerebral oedema...

3

What are the four important types of brain herniation?

Cingulate / Subfalcine

Central

Uncal

Tonsilar

4

Which lobe is involved in a cingulate herination?

Most of them

Cingulate gyrus runs along the midline

5

What does the cingulate gyrus herniate underneath?

Does it move medially or laterally?

Falx cerebri (lining of dura running down the midline)

Medially

6

What structure may be damaged by a cingulate/subfalcine herniation?

Anterior cerebral artery

7

Which artery is most at risk of damage in a subfalcine herniation?

Anterior cerebral artery

8

Which part of the brain does the anterior cerebral artery supply?

Medial cerebral hemispheres - from frontal to parietal lobes

Corpus callosum

Caudate nucleus

9

Which symptoms are caused by a cingulate / subfalcine herniation?

Contralateral leg weakness

legs map to areas of motor strip supplied by anterior cerebral artery, and remember motor pathways cross over so damage affects the opposite side

10

Which lobe shifts in an uncal herniation?

Temporal lobe

11

In an uncal herniation, the temporal lobe passes through an opening in which structure?

Tentorium cerebelli

12

Which structures does the brain herniate through in

a) cingulate

b) uncal herniations?

a) Falx cerebri

b) Tentorium cerebelli

13

Which symptoms are caused by uncal herniation?

Dilation of ipsilateral pupil (compression of CN III)

Contralateral hemiparesis (compression of medullary pyramids, where motor fibres cross over, causes muscle weakness)

14

Which symptoms are seen in

a) cingulate

b) uncal herniations?

a) Contralateral leg weakness

b) Ipsilateral dilation, contralateral hemiparesis

15

In which herniation does the cerebellum pass through the foramen magnum?

Tonsilar herniation

16

Which

a) part of the brain

b) bony structure

is involved in tonsilar herniation?

a) Cerebellum

b) Foramen magnum

17

Which symptoms are caused by tonsilar herniation?

Cushing's triad

Hypertension

Bradycardia

Irregular breathing

caused by compression of centres in the medulla

18

What congenital malformation, causing narrowing of the spinal cord, may tonsilar herniation be caused by?

Chiari malformation

Narrowing of the spinal cord which causes CSF blockage > increased ICP

19

What is a central herniation of the brain?

Downwards movement of brainstem towards the tentorium cerebelli

20

Which important space, containing venous blood, the internal carotid artery and a cranial nerve, is compressed in central herniation?

Cavernous sinus

21

Which cranial nerve travels in the cavernous sinus?

CN VI

Abducent nerve

22

What symptom is caused by compression of CN VI in a central herniation?

Diplopia

23

Which symptoms are caused by

a) tonsilar

b) central

herniations?

a) Cushing's triad (hypertension, bradycardia, irregular breathing)

b) Diplopia

24

Which symptoms are caused by

a) tonsilar

b) subfalcine

c) uncal

d) central

herniations?

a) Cushing's triad (hypertension, bradycardia, irregular breathing)

b) Contralateral leg weakness

c) Ipsilateral dilation, contralateral hemiparesis

d) Diplopia