1 - Zil - Meninges + Venous Sinuses

Question 1

Hematoma

Answer 1

Abnormal mass of blood outside blood vessel

Question 2

Arterial Supply to Head

Answer 2

Common Carotid Arteries

Verterbral Artery

Question 3

Carotid Pulse

Answer 3

Sternocleidomastoid Muscle

Vertebral Level C4

Lateral to Throid Cartilage

Question 4

Venous Drainage From Head

Answer 4

Right/Left Internal Jugular Vein

Question 5

Carotid Siphon

Answer 5

C-shaped turn of Internal Carotid Artery

Passes through cavernous sinus

Question 6

Entrance of major arteries of skull?

Answer 6

Internal Carotid - enters skull via Carotid Canal and Foramen Lacerum

Vertebral Artery - enters skull via Foramen Magnum

Question 7

Dura Mater

Answer 7

Tough connective tissue layer, composed of two layers

1. Inner Membrane Layer (true dura)
2. Outer Endosteal Layer - periosteum on inner side of calvarium
   - - -

Layers fused in most places, separate to form Dural Reflections

Question 8

Extra Space in skull?

Answer 8

Normally none, as dura is fused to bone

Unline spinal cord, there is NO epidural space

Question 9

Dural Reflection

Answer 9

Two folded layers of Inner Membrane (true dura)

Contain venous sinuses

Question 10

Falx Cerebri

Answer 10

Sickle shaped dural reflection between cerebral hemispheres

Attached:

Ant. to Crista Galli of Ethmoid

Post. Blends into Tentorium Cerebelli

Question 11

Falx Cerebelli

Answer 11

Smaller barrier between cerebellar hemispheres along posterior wall of Post. Cranial Fossa

Question 12

Tentorium Cerebelli

Answer 12

Forms roof of Posterior Cranial Fossa

Like a Tent

Has notch for pass of brainstem

Question 13

Diaphragma Sella

Answer 13

Fold over sella turcica

Opening for stalk of pituitary

Question 14

Tentorial Notch

Answer 14

Opening for brainstem

Question 15

Arachnoid layer

Answer 15

Attached to inner side of dura (potential space = Subdural Space)

Question 16

Pia Mater

Answer 16

Adheres to brain

Question 17

Subarachnoid Space

Answer 17

contains CSF

Question 18

Bridging Veins

Named veins?

Answer 18

Inside cranial cavity

Drain blood from surface of brain

- - -

Great Cerebral Vein of Galen

Question 19

Emissary Veins

Named Veins?

Answer 19

Drain blood from scalp, to venous sinuses

- - -

Named Veins: Opthalmic Veins from eye (orbit)

Question 20

Superior Sagittal Sinus

Answer 20

In Upper Border of Falx Cerebri

Communicates laterally with venous lacunae, blood from Superior Cerebral veins through bridging veins, some also from emissary veins

Question 21

Emissary Veins vs Bridging Veins

Answer 21

Emissary Vein - Scalp to Sinus, Scalp to Diploe, Diploe to Sinus

Bridging Vein - Cerebral Vein (brain) to Sinus

Question 22

Inferior Sagittal Sinus

Answer 22

In lower (free) border of falx cerebri, joins Great Cerebral Vein to form Straight Sinus

***Does NOT join Superior Sagittal Sinus

Question 23

Straight Sinus

Answer 23

Junction of Falx Cerebri and Tentorium

Question 24

Transverse Sinuses

Answer 24

In Lateral Fixed Part of Tentorium

Receive blood from Superior Sagittal or Confluens

Question 25

Sigmoid Sinuses

Answer 25

S-shaped **continuation of Tranverse,** end in Jugular Foramen; **Form Internal Jugular Vein**

Question 26

Occipital Sinus

Answer 26

In **Falx Cerebelli**, drain to **Confluens**

Question 27

Cavernous Sinuses

Answer 27

In middle of **Cranial Fossa**, on side of the body of the **sphenoid bone** Connected by **Intercavernous Sinus** Receive blood from Sup. and Inf **Ophthalmic Veins**, **Cerebral Veins** Drain to Sup. and Inf. **Petrosal Sinuses**

Question 28

Superior and Inferior Petrosal Sinuses

Answer 28

On Petrous part of Temporal Bone - - - Superior - Drains to Tranverse Inferior - Drains to internal Jugular

Question 29

Clinical: Spread of Infection on Face?

Answer 29

Infection can spread from Face to **Cavernous Sinus** via anastomoses of **Ophthalmic Veins** and **Facial Veins**

Question 30

Structures Passing Through Wall of Cavernous Sinus Clinical Sign of Infection?

Answer 30

Int. Carotid Artery Cranial Nerves: 3, 4, 5.1, 5.2, 6 Clinical Sign of Infection: **Blurred Vision (Diplopia)**

Question 31

Cerebro Spinal Fluid (CSF)

Answer 31

Made inside brain in **Choroid Plexus** Flows out of brain to **Subarachnoid Space** Brain floats - Shock absorber

Question 32

CSF Reabsorption? Clinical

Answer 32

CSF Reabsorbed into Venous Sinuses at **Arachnoid Villi** **- - -** **Clinical: In elderly** Arachnoid Villi can become **calcified - _Arachnoid Granulations;_** reduced re-absorption can produce **Communicating Hydrocephalus (increased CSF pressure)**

Question 33

Communicating Hydrocephalus

Answer 33

In elderly when Arachnoid Villi can become calcifies leading to Arachnoid Granlations ## Footnote **Increased CSF pressure due to REDUCED reabsorption of CSF**

Question 34

Epidural Hematoma Clinical?

Answer 34

Bleeding between dura and bone 1. Skull fracture near **Pterion** 2. Tear **Middle Meningeal Artery** 3. Blood peels **dura from bone** 4. **Lens Shaped (biconvex) mass on CT** **- - -** **Clinical:** Patient LUCID at first, rapid decline, fatal within hours if **Uncal Herniation** occurs

Question 35

Uncal Herniation Tonsillar Herniation

Answer 35

Uncal - Push **Temporal Lobe (uncus)** through **Tentorial Notch** Tonsillar Herniation - Push **Cerebellum (tonsil)** through **Foramen Magnum**

Question 36

Subdural Hematoma

Answer 36

1. **Venous** 2. **Crescent Shaped Mass** 3. **Slow** **- - -** Bleed into potential space between **Dura** and **Arachnoid** From **tear Bridging Vein** or **Sinus** Bleeding often **SLOW** Chronic hematomas can remain **undetected, herniation may result**

Question 37

Subarachnoid Hematoma

Answer 37

Tearing cerebral artery or aneurysm, or cerebral vein IF arterial, can be **rapid** and **fatal**

Question 38

Berry Aneurysm

Answer 38

**Aneurysm in Circle of Willis, 50% fatal if burst**