A 62-year-old man is brought to the emergency department after his wife found him unresponsive 1 hour ago. He had fallen from a flight of stairs the previous evening. He has hypertension and coronary artery disease. Current medications include aspirin, enalapril, metoprolol, and atorvastatin. On arrival, he is unconscious. His temperature is 37.3°C (99.1°F), pulse is 89/min, and blood pressure is 150/92 mm Hg. CT scan of the head without contrast demonstrates an acute hemorrhage in the left temporal lobe with compression of the anterior medial temporal lobe against the free margin of the tentorium cerebelli. Which of the following cranial nerves is most likely to be compromised in this patient?

Question

A 62-year-old man is brought to the emergency department after his wife found him unresponsive 1 hour ago. He had fallen from a flight of stairs the previous evening. He has hypertension and coronary artery disease. Current medications include aspirin, enalapril, metoprolol, and atorvastatin. On arrival, he is unconscious. His temperature is 37.3°C (99.1°F), pulse is 89/min, and blood pressure is 150/92 mm Hg.  CT scan of the head without contrast demonstrates an acute hemorrhage in the left temporal lobe with compression of the anterior medial temporal lobe against the free margin of the tentorium cerebelli.  Which of the following cranial nerves is most likely to be compromised in this patient?

Quizplus · Accepted Answer

Eductional Objective: Uncal herniation is a possible complication of an expanding ipsilateral mass lesion (eg, hemorrhage, tumor).  The first sign of uncal herniation is a fixed, dilated pupil on the side of the lesion.  Contralateral or ipsilateral hemiparesis and contralateral homonymous hemianopsia with macular sparing may also occur.

A 62-Year-Old Man Is Brought to the Emergency Department After