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Neuro M2T2 Ex 1 > 2. Meninges and CSF > Flashcards

2. Meninges and CSF Flashcards

1
Q

What does the dura cover?

A

Brain, spinal cord, cranial nerves, optic chiasm

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2
Q

Where are sinuses located?

A

Within the dura mater

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3
Q

Where do the sinuses drain venous blood?

A

Jugular veins –> SVC

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4
Q

What landmark distinguishes the end of the brainstem and the beginning of the spinal cord?

A

Foramen Magnum

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5
Q

Falx cerebri

A

Attached to skull, goes down to corpus callosum

Separates brain into two hemispheres

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6
Q

Where is the superior sagittal sinus?

A

Top of falx cerebri

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7
Q

Tentorium cerebelli vs falx cerebelli

A

Tentorium cerebelli covers the top of the cerebellum, separates it from the occipital lobe
Falx cerebelli divides the cerebellum into two hemispheres

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8
Q

What is the tentorium notch?

A

It is the space in the tentorium cerebelli through which the brainstem passes

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9
Q

What happens during uncal herniation?

A

Increased intracranial pressure (ICP) causes the uncus to herniate and get stuck under the tentorial notch

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10
Q

Epidural space in brain vs spinal cord

A

In brain, it is a potential space
In SC, it is a real space

Space between skull and dura; space between dura and vertebrae

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11
Q

Is the subdural space a real space or a potential space?

A

Potential space. Dura and arachnoid are usually fused

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12
Q

In which meningeal space is the CSF?

A

Subarachnoid space

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13
Q

In what cases do epidural hematomas occur? Describe what happens

A

Tearing of middle meningeal artery or tearing of venous sinus –> quick bleeding –> accumulation of blood –> rapid rise of pressure (dura can dissect off bone)

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14
Q

Where does the bleeding occur with an epidural hematoma vs subdural hematoma?

A

Epidural = above dura; subdural = inbetween dura mater and arachnoid

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15
Q

Consequences of epidural hematoma?

A

Compression and midline shift of brain
Can effect/damage optic chiasm (dilated pupil that doesn’t constrict)
Coma and death can result

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16
Q

Consequences of subdural hematoma?

A

Dissect arachnoid off dura; blood distributed throughout entire hemisphere
Can also lead to brain compression, similar symptoms as epidural
Slower onset than epidural since it involves brain

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17
Q

Subdural hematoma involves damage to what structure(s)? Significance of this?

A

Cerebral vein; bleed is lower pressure and occurs more slowly

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18
Q

Why does the risk of tearing increase as we age?

A

Brain shrinks, pulls away from sinus –> greater risk for tears

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19
Q

Younger people and more susceptible to _________ hematomas, and elderly are more susceptible to ______________ hematomas.

A

Younger people –> epidural hematomas

Elderly –> subdural hematomas

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20
Q

Composition of CSF

A

little glucose/protein/cells, chloride

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21
Q

What happens to CSF with meningitis?

A

CSF may be cloudy with presence of bacteria (also notable difference in composition of CSF)

22
Q

Functions of CSF (6)

A

Bouyancy and support
Cushion and protect
Nourishment
Reservoir and regulation of the contents of skull
Removes metabolites
Pathway for pineal secretions to reach pituitary gland

23
Q

Where is choroid plexus located?

A

In all of the four ventricles

24
Q

Describe the flow of CSF

A

lateral ventricles –> interventricular foramin of Monroe –> 3rd ventricle –> cerebral aqueduct –> 4th ventricle
If it goes through foramin of magendie (median aperture) –> flows up around the brain into subarachnoid space
If it goes through the foramen of luschka (lateral aperture)–> flows in and around SC

25
Q

Subarachnoid cisterns

A

Separation of pia and arachnoid further, allowing for CSF to pool in these areas called cisterns.

pia adheres to the surface of the brain, but arachnoid covers only superficial surface. In certain areas around brain, the pia and arachnoid are separated widely; in such regions are formed cavities called the subarachnoid cisterns

26
Q

Name the three cisterns

A

Quadrigeminal cistern
Pontine cistern
Cisterna magna

27
Q

Location of the three cisterns

A

Quadrigeminal - between superior and inferior colliculi of brain
Pontine - ventral aspect of pons
Cisterna magna - below fourth ventricle at level of medulla (below-ish of cerebellum)

28
Q

Where does lumbar puncture occur?

A

Level of iliac crest (L4); damage doesn’t occur because no SC at this segment, only cauda equina

29
Q

Arachnoid villus. What does it do?

A

Protrusions of arachnoid into dural sinus
Reabsorb CSF into venous sinus –> one way flow from subarachnoid space into venous blood (can move through large vacuoles or paracellularly)

30
Q

Difference between arachnoid villus and arachnoid granules

A

Individual tufts = villus

Groups of arachnoid villi = granules

31
Q

Brain receives what percent of CO and O2?

A

Receives 15% of CO, 20% of O2

32
Q

Does the brain’s metabolic rate vary with state and activity?

A

Varies ONLY SLIGHTLY with state and activity

33
Q

What conditions can vary the metabolic rate of the brain?

A

General anesthetics, hypoglycemic coma, and seizures

34
Q

Under what MABP does autoregulation NOT occur?

A

60-150mmHg

35
Q

Which conditions would cause a vasodilation?

A

Inc. PCO2
Dec O2
Inc H+

36
Q

Which conditions would cause a vasoconstriction?

A

Inc. PO2

Dec PCO2

37
Q

Equation relating MABP, ICP, and CPP

A

CPP = MABP - ICP

38
Q

What is ICP

A

intracranial pressure = pressure of the fluid in the brain

39
Q

What is normal ICP (in mmH20 and mmHg)?

Elevated ICP?

A

65-150mmH20
5-15mmHg

Elevated ICP: >20mmHg

40
Q

At what ICP does cerebral circulation collapse?

A

ICP = 90-100mmHg

When ICP > MABP

41
Q

What are the three main herniations that can occur in the brain?

A

Cingulate gyrus herniation, uncal herniation, tonsil herniation

42
Q

In which case does cingulate gyrus herniation occur

A

Occurs with subdural hematoma

43
Q

Tonsil hernation

A

occurs when tonsil of cerebellum herniates through foramen magna leading to compression of medulla

44
Q

Symptoms of inc ICP

A

Headache, papilledema, altered mental status, increased BP, decreased HR

45
Q

What is papilledema

A

Effusion or edema in and around eye = eye appears cloudy

46
Q

What is Cushing’s reflex (triad)

A

Inc systolic BP, inc pulse pressure, dec HR

47
Q

What are the three types of cerebral edema?

A

vasogenic edema, cytotoxic edema, and interstitial edema

48
Q

Describe vasogenic edema

A

Inc permeability of BBB leads to an increase in ECF

49
Q

Describe cytotoxic edema

A

Due to hypoxia or failure of Na/K pump –> inc intracellular fluid and cell swelling

50
Q

Describe interstitial edema

A

inc edema and fluid in white matter around ventricles, due to hydrocephalus or increased CSF

51
Q

How to lower ICP

A

Hyperventilate with respirator
Elevate head to 30 degrees
Maintain BP in normotensive state
(High BP inc ICP, low BP compromises cerebral blood flow)

Neuro M2T2 Ex 1 (18 decks)

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