Block 13 Traum Brain Inj Raised Icp MCQ's
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Following even minor trauma to the brain (i.e. mild concussion), most patients complain of headache for varying periods ranging from a few minutes to several days and up to a year. Which one of the following mechanisms may help to explain the causation of post-traumatic headache?
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Activation of nociceptors in the bone overlying the point of minor trauma
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Activation of nociceptors in muscles of the scalp and neck
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Activation of the neo-spinothalamic tract reaching consciousness
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Activation of the paleospinothalamic tract reaching consciousness
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High levels of serotonin in blood due to stress related to the trauma
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This quiz focuses on traumatic brain injuries and raised intracranial pressure, exploring mechanisms of post-traumatic headaches, effects of herniation, and types of hematomas. It assesses understanding of clinical presentations and emergency responses relevant to neurology and trauma medicine.
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A 24-year-old man was pushed down a flight of stairs in a fight. He briefly lost consciousness, then regained consciousness and went to dinner. After 1h at the restaurant he lost consciousness again. He was rushed to the emergency room and after airway, breathing and circulation were assessed and secured a CT scan of the head was performed. An eye exam showed a fixed and dilated right pupil. The most likely pathology in this patient is:
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Subdural hematoma
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Epidural hemorrhage/hematoma
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Brain concussion
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Brain stem herniation
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Brain laceration
Correct Answer
A. Epidural hemorrhage/hematomaExplanation
The most likely pathology in this patient is epidural hemorrhage/hematoma. This is suggested by the history of head trauma followed by a brief loss of consciousness, regaining consciousness, and then losing consciousness again after a period of time. The fixed and dilated right pupil on eye exam is indicative of increased intracranial pressure, which is commonly seen in epidural hematoma. A CT scan of the head would confirm the diagnosis by showing a collection of blood between the skull and dura mater.Rate this question:
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- 3.
A 24 years old man had a motor vehicle accident with a head trauma that resulted in fracture of skull above and anterior to external ear. You expect extradural hemorrhage and increase in intracranial pressure. If that leaded to herniation of uncus of the temporal lobe of the brain, it can cause
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Bilateral upward deviation of the eyeball.
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Deviation of the tongue opposite to the side of lesion.
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Paralysis of the muscles of mastication bilaterally.
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Facial paralysis on the side of lesion.
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Fixed and dilated pupil on the side of lesion.
Correct Answer
A. Fixed and dilated pupil on the side of lesion.Explanation
The fracture of the skull above and anterior to the external ear suggests a possible injury to the middle meningeal artery, which can result in an extradural hemorrhage. This hemorrhage can lead to an increase in intracranial pressure. If the pressure continues to rise, it can cause herniation of the uncus of the temporal lobe. This herniation can compress the oculomotor nerve, leading to a fixed and dilated pupil on the side of the lesion.Rate this question:
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- 4.
If a 40-year-old woman, diagnosed with an acute right subdural hematoma, suddenly develops a right ptosis with a dilated pupil non-reactive to light, the most likely cause is:
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Acute hydrocephalus
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Occipital lobe infarct
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Laceration of ipsilateral pedunculus
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Laceration of contralateral pedunculus
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Transtentorial hypoccampal herniation
Correct Answer
A. Transtentorial hypoccampal herniationExplanation
Transtentorial herniation refers to the displacement of brain tissue through the tentorial notch, which can compress and damage structures in the brainstem. The clinical findings described in the question, including right ptosis and a dilated pupil non-reactive to light, are consistent with a third nerve palsy caused by compression of the oculomotor nerve. This is a classic sign of transtentorial herniation. Acute hydrocephalus, occipital lobe infarct, and lacerations of the pedunculi would not typically present with these specific findings.Rate this question:
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- 5.
Concerning acute subdural hematomas, choose the correct answer:
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They are caused by traumatic injury only
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They arise from tearing of bridging veins
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They arise from tearing of middle meningeal arteries
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They are most commonly present at the base of the brain
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They are often unilateral
Correct Answer
A. They arise from tearing of bridging veinsExplanation
Acute subdural hematomas are caused by tearing of bridging veins. These veins connect the surface of the brain to the dural sinuses, which are large veins located between the layers of the meninges. When a traumatic injury occurs, such as a blow to the head, these bridging veins can tear, leading to bleeding between the dura mater and the arachnoid membrane. This accumulation of blood can put pressure on the brain and cause symptoms such as headaches, confusion, and neurological deficits. Unlike epidural hematomas, which are commonly caused by tearing of middle meningeal arteries, acute subdural hematomas are typically associated with bridging vein injuries.Rate this question:
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- 6.
The earliest manifestations of uncal herniation are associated with:
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Tears of basilar artery with Duret hemorrhage
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Compression of posterior and superior cerebellar arteries and cerebellar infarctions
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Compression of cranial nerve III
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Compression and tears of cerebral peduncles
Correct Answer
A. Compression of cranial nerve IIIExplanation
Compression of cranial nerve III is associated with the earliest manifestations of uncal herniation. This occurs when there is increased pressure in the brain, causing the uncus to herniate and compress the oculomotor nerve (cranial nerve III). This compression leads to a variety of symptoms, including pupillary dilation, ptosis (drooping of the eyelid), and impaired eye movement. These symptoms are often observed before other signs of uncal herniation, such as brainstem compression or infarctions.Rate this question:
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- 7.
Which of the following brain changes are characteristic for diffuse axonal injury?
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Cerebral edema with herniation
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Widespread areas of cortical and subcortical hemorrhages
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Axonal swelling
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Neuronal swelling and dissolution of Nissl substance
Correct Answer
A. Axonal swellingExplanation
Diffuse axonal injury is characterized by axonal swelling, which occurs due to the shearing forces applied to the brain during the injury. This swelling can disrupt the normal functioning of the axons and impair the transmission of nerve impulses. Other changes such as cerebral edema with herniation, widespread areas of cortical and subcortical hemorrhages, and neuronal swelling with dissolution of Nissl substance may be seen in different types of brain injuries, but they are not specifically characteristic for diffuse axonal injury.Rate this question:
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- 8.
Which of the following conditions are indications for spinal tap?
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Chronic meningitis and increased intracranial pressure
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Increased intracranial pressure due to intracranial mass
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Acute meningitis and subarachnoid hemorrhage due to berry aneurysm rupture
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Acute meningitis and intracerebral hemorrhages due to hemophilia A
Correct Answer
A. Acute meningitis and subarachnoid hemorrhage due to berry aneurysm ruptureExplanation
Spinal tap, also known as a lumbar puncture, is a procedure used to collect and analyze cerebrospinal fluid (CSF) from the spinal canal. It is indicated in cases of acute meningitis and subarachnoid hemorrhage due to berry aneurysm rupture. Acute meningitis is an inflammation of the membranes surrounding the brain and spinal cord, while subarachnoid hemorrhage refers to bleeding in the space between these membranes. By performing a spinal tap, the CSF can be examined for signs of infection or bleeding, helping to diagnose and guide treatment for these conditions. The other options listed do not specifically indicate the need for a spinal tap.Rate this question:
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Current Version
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Mar 22, 2023Quiz Edited by
ProProfs Editorial Team -
Aug 29, 2012Quiz Created by
Chachelly
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