ICP and Brain herniation

Question 1

___________ 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)

Answer 1

Monro-Kellie principle

Question 2

Explain subfalcine herniation

Answer 2

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

Question 3

Uncal herniation usually compress what nerve that control eye movements?

Answer 3

CNIII

mass effect caused by a supratentorial lesion → medial and downward displacement of the uncus at the tentorial incisure

Question 4

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

Answer 4

c) Cerebral edema

Question 5

What is the earliest sign of increased ICP?
a) Papilledema
b) Altered mental status
c) Headache
d) Seizures

Answer 5

c) Headache

Question 6

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

Answer 6

c) Tonsillar herniation

Question 7

What is the most common cause of brain herniation?
a) Traumatic brain injury
b) Cerebral infarction
c) Brain tumor
d) Hydrocephalus

Answer 7

C) Brain tumour

Question 8

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

Answer 8

C

Question 9

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:

Answer 9

c) Hypertension, bradycardia, and Cheyne-Stokes respirations

Question 10

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)

Answer 10

a) Computed tomography (CT) scan

Question 11

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

Answer 11

d) Surgical decompression

Question 12

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

Answer 12

c) Brainstem compression

Question 13

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

Answer 13

a) Hyperoxygenation

Question 14

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

Answer 14

b) Transcranial Doppler ultrasound

Question 15

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

Answer 15

b) Subfalcine herniation

Question 16

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

Question 17

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

Answer 17

B

Question 18

Which of the following is a risk factor for the development of brain herniation?
a) Hypotension
b) Hypercapnia
c) Hypoglycemia
d) Hyponatremia

Answer 18

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.

Question 19

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)

Answer 19

A

Question 20

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

Answer 20

c) Promoting brain oxygenation

Question 21

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)

Answer 21

A

Question 22

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

Answer 22

A