A patient with a brain tumour that is increasing intercranial pressure is classed as which ASA grade?

• A. II or 2
• B. III or 3
• C. IV or 4
• D. V or 5

Answer: (C)

The situation tests understanding of the ASA physical status classification and how stability and threat to life influence perioperative risk. A brain tumour with increasing intracranial pressure creates a life‑threatening, unstable condition—the ICP can rapidly worsen, risking brain herniation and rapid deterioration. That level of risk places the patient in ASA IV: a severe systemic disease that is a constant threat to life. It’s more serious than ASA III, where the systemic disease is severe but not consistently life‑threatening, and it’s not ASA V, which describes a moribund patient not expected to survive without the operation. If the scenario were an emergency, you’d add the E modifier, but the underlying grade remains IV.