A traumatic brain injury client has developed extreme cerebral edema. The nurse is monitoring the client closely for signs of brain herniation

Question

Which clinical manifestations would correlate to upward herniation of the midbrain from the infratentorial compartment? Select all that apply.
A) Deep coma
B) Rhythmic movement of arms and legs
C) Respiratory rate of 8 with intermittent sighs
D) Intracranial bleeding from nose and ears
E) Bilateral small, fixed pupils

Answer 1

Ans: A, C, E
Feedback:
Infratentorial herniation results from increased pressure in the infratentorial compartment. Herniation may occur superiorly (upward) through the tentorial incisura or inferiorly (downward) through the foramen magnum. The most prominent signs of upward herniation include immediate onset of deep coma; small equal, fixed pupils; and abnormal respirations (slow rate with intermittent sighs or ataxia) and other vital signs. Downward displacement of the midbrain through the tentorial notch or of the cerebellar tonsils through the foramen magnum can interfere with medullary functioning and cause cardiac or respiratory arrest. Tissue infarction and intracranial bleeding are causes of cerebral edema, rather than an outcome of herniation. Rhythmic movement of arms and legs could be caused by many things and is not specific to infratentorial herniation.