drk1980
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A 50-year-old male presents with headaches, vomiting, and weakness of his left side. Physical examination reveals his right eye to be pointing “down and out” along with ptosis of his right eyelid. His right pupil is fixed and dilated and does not respond to accommodation. Marked weakness is found in his left arm and leg. Swelling of the optic disk (papilledema) is found during examination of his retina. Which one of the following is most likely present in this individual?
1. Aneurysm of the vertebrobasilar artery
2. Arteriovenous malformation involving the anterior cerebral artery
3. Subfalcine herniation
4. Tonsillar herniation
5. Uncal herniation
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| vemi007
Forum Senior
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the answer is Uncal Herniation - 5. Is it correct?
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| msyamp
Forum Guru
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must be uncal herniation.
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| drk1980
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very good!
for futher reading....
Increased intracranial pressure can result from mass lesions in the brain, cerebral edema, or hydrocephalus. Increased intracranial pressure can cause swelling of the optic nerve (papilledema), headaches, vomiting, or herniation of part of the brain into the foramen magnum or under a free part of the dura.
Brain herniations are classified according to the area of the brain that is herniated:
Subfalcine herniations are caused by herniation of the medial aspect of the cerebral hemisphere (cingulate gyrus) under the falx, which may compress the anterior cerebral artery.
Transtentorial herniation, which occurs when the medial part of the temporal lobe (uncus) herniates over the free edge of the tentorium, may result in compression of the oculomotor nerve, which results in pupillary dilation and ophthalmoplegia (the affected eye points “down and out”).
Tentorial herniation may also compress the cerebral peduncles, within which are the pyramidal tracts. Ipsilateral compression produces contralateral motor paralysis (hemiparesis), while compression of the contralateral cerebral peduncle against Kernohan’s notch causes ipsilateral hemiparesis. Further caudal displacement of the entire brainstem may cause tearing of the penetrating arteries of the midbrain (Duret hemorrhages). This caudal displacement may also stretch the trochlear nerve (cranial nerve VI), causing paralysis of the lateral rectus muscle (the abnormal eye turns inward).
Masses in the cerebellum may cause tonsillar herniation, in which the cerebellar tonsils are herniated into the foramen magnum. This may compress the medulla and respiratory centers, causing death. Tonsillar herniation may also occur if a lumbar puncture (LP) is performed in a patient with increased intracranial pressure. Therefore, before performing an LP, check the patient for the presence of papilledema.
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| hellohie
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UNCAL HERNIATION.
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| leen
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thanks drk
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| ureterpolyp
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