Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury

Question

He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.
A)
Clouding of consciousness
B)
Decorticate posturing with painful stimulation
C)
Pupils fixed at approximately 5 mm in diameter
D)
Respiration rate of 40 breaths/minute
E)
Decerebrate posturing following painful stimulation of the sternum

Answer 1

Ans:
C, D, E

Feedback:

With midbrain involvement, pupils are fixed and midsized (5 mm in diameter), and reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and respirations change from Cheyne-Stokes respiration to neurogenic hyperventilation. Cloudiness of consciousness occurs in early diencephalic stages. Decorticate posturing with pain occurs in the diencephalic stage.