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Neuro > 4 - Circulation to the Brain and Spinal Cord: CSF and Vascular Systems > Flashcards

4 - Circulation to the Brain and Spinal Cord: CSF and Vascular Systems Flashcards

1
Q

CSF is formed in ____ (more specifically ___ ___) and flows between ventricles and into ____ space

A

ventricles, choroid plexus
subarachnoid space

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2
Q

2 functions of the CSF?

A
  1. supplying nutrients and removing waste products - it is then absorbed into venous system
  2. along with meninges, provides shock absorption to brain when head is hit
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3
Q

What is the lateral wall of the lateral ventricles?

A

caudate nucleus - with tail of caudate superior to inferior horn of lateral ventricle

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4
Q

What is below body of lateral ventricle? above?

A

below: thalamus
above: corpus callosum

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5
Q

what connects the lateral ventricles to each other and to 3rd ventricle?

A

interventricular foramina/foramina of Monro

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6
Q

The 3rd ventricle is narrow in midline of what?

A

diencephalon

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7
Q

what is the 3rd ventricle surrounded by?

A

thalamus and hypothalamus

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8
Q

what connects 3rd and 4th ventricles thru midbrain?

A

cerebral aqueduct/aqueduct of sylvius

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9
Q

4th ventricle is posterior to what? anterior to?

A

posterior to pons/medulla
anterior to cerebellum

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10
Q

what does the 4th ventricle connect to? (inferior of it)

A

central canal of spinal cord

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11
Q

what does the 4th ventricle drain into? through what?

A

drains into subarachnoid space through 2 lateral foramina (foramina of luschka) and midline foramen of Magendie

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12
Q

__ mater: outer layer firmly attached to inside of skull and inner layer attached to arachnoid

A

dura

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13
Q

dura mater: inner and out layers fused except where?

A

dural sinuses which collect CSF and venous blood

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14
Q

2 dense projections of inner layer of dura? locations?

A
  1. falx cerebri (sagittal)
  2. tentorium cerebelli (frontal)
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15
Q

Unique interaction between dura and arachnoid mater?

A

arachnoid mater has villi/granulation that go thru dura into venous sinuses to allow CSF flow into them

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16
Q

pia mater is connected to arachnoid through ___ ___ (collagen fibers) to allow suspension of brain in CSF?

A

arachnoid trabeculae

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17
Q

To make CSF, blood is filtered and transported thru which 3 layers?

A

web of (1) capillaries embedded in (2) connective tissue and (3) epithelial cells

  • creates a protein rich substance like plasma
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18
Q

Most often cause of epidural hematoma?

A

fx of parietal or temporal bones tearing middle meningeal artery

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19
Q

is an epidural hematoma usually a quick or slow accumulation of blood?

A

quick

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20
Q

is a subdural hematoma usually a quick or slow accumulation of blood?

A

slow

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21
Q

which hematoma is characterized with a period of lucidity then quick deterioration?

A

epidural

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22
Q

which hematoma is characterized by its “lens” shape?

A

epidural

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23
Q

what is a subdural hematoma most often due to?

A

venous bleed

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24
Q

what hematoma is characterized by a long broad crescent moon shape?

A

subdural

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25
Q

is hydrocephalus congenital, acquired or either?

A

can be either

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26
Q

Triad of symptoms of hydrocephalus?

A

worsening gait, incontinence, HA or cognitive deficits

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27
Q

___ hydrocephalus occurs when the ventricular system is intact with blockage caudal to 4th ventricle

A

communicating

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28
Q

____/____ hydrocephalus occurs when the blockage is within the ventricular system (usually cerebral aqueduct)

A

noncommunicating/obstructive

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29
Q

what makes pain worse with meningitis?

A

upright position, head movement, sneezing or coughing

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30
Q

which homunculus is on the post central gyrus?

A

sensory

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31
Q

which homunculus is on the pre central gyrus?

A

motor

32
Q

about how much of the spinal cord does the anterior spinal artery supply?

A

2/3

33
Q

what is it called when arteries connect to abnormal
vessels rather than capillaries to
veins?

A

arteriovenous malformation (AVM)

  • congenital
  • can be asymptomatic until rupture
  • can be found anywhere in the brain
34
Q

what is a thin walled outpouching
from artery or vein?

A

aneurysm

Can be congenital and
worsen with age, HTN
► Or can develop with time
► Can be asymptomatic until
it leaks or ruptures
► Can be found anywhere in
circulatory system

35
Q

what is the specialized barrier between
capillary endothelium of CNS and extracellular space?

A

blood brain barrier

36
Q

Blood brain barrier is absent in areas that __ the blood or ____ into
the blood.

A

sample, secrete

37
Q

where in the brain is the blood brain barrier absent?

A

Parts of hypothalamus and other areas close to 3rd/4th
ventricles

  • Special ependymal cells separate “leaky” regions from
    barriered ones (like a barrier between the barrier and non-barrier regions)
38
Q

O2 use ____ (inc/dec) from brainstem to cerebral cortices

A

increases

  • Cortex more vulnerable to O2 loss than life centers of brainstem
  • May explain why some people can live in persistent vegetative state for long time
39
Q

Cerebral arteries autoregulate local blood flow dependent on blood
pressure and metabolism. What would cause arteries to dilate?

A
  • low BP
  • low O2
  • low pH
  • high CO2
  • high lactic acid
40
Q

Cerebral arteries autoregulate local blood flow dependent on blood
pressure and metabolism. What would cause arteries to constrict?

A
  • high BP
  • high O2
  • high pH
  • low CO2
  • low lactic acid
41
Q

Excessive fluid in brain tissue is known as what?

A

cerebral edema

42
Q

3 potential causes of cerebral edema?

A
  1. TBI, including concussion
  2. heart attack
  3. high altitude cerebral edema (HACE)
43
Q

Cerebral edemas are often progressive because fluid pressure causes ___ then causing
arterioles to dilate which increases ____ ____ and permeability
and more edema

A

ischemia, capillary pressure

  1. fluid pressure > ischemia
  2. ischemia > arterioles to dilate
  3. arterioles dilate > increased capillary pressure and permeability
  4. increased capillary pressure and permeability > more edema
44
Q

Intracranial pressure is monitored by a monitor placed where?

A

lateral ventricle

45
Q

Normal intracranial pressure?

A

5-15 mmHg

46
Q

Intracranial pressure above __ is abnormal and __ or greater is pathologic and contraindication
to PT.

A

15, 20

47
Q

What can excessive ICP do?

A
  1. move brain structures
  2. compress brain tissue
  3. cause brain herniation
  4. cause hydrocephalus
  5. disrupt blood supply
48
Q

4 types of brain herniation?

A
  1. cingulate
  2. uncal
  3. central
  4. tonsillar
49
Q

what type of brain herniation causes pressure on the falx cerebri and can cause issues with the lower limbs?

A

cingulate

50
Q

what type of brain herniation has pressure against the midbrain causes CN 3 dysfunction and LOC (reticular activating system)?

A

uncal

51
Q

what type of brain herniation has pressure against diencephalon moving it, midbrain and pons down?

A

central

52
Q

what type of brain herniation stretches basilar artery with brainstem ischemia/edema and causes B paralysis and impaired consciousness and oculomotor
function?

A

central

53
Q

what type of brain herniation has pressure of cerebellar tonsils on brainstem impair consciousness and 4th ventricle?

A

tonsillar

54
Q

Venous system: spinal cord and medulla drain into small veins into ___ veins into ____ ___ ___

A

radicular, epidural venous plexus

55
Q

Venous system: cerebral veins drain into dural sinuses into ___ ___ vein

A

internal jugular

56
Q

Venous system: superficial veins drain cortex and neighboring white matter into ___ ___ __ or sinus at inferior cerebrum

A

superior sagittal sinus

57
Q

Venous system: deep cerebral veins drain basal ganglia, diencephalon, adjacent white matter into ___ ___

A

straight sinus

58
Q

Venous system: superior sagittal and straight sinuses meet at ___ ___ __

A

confluence of sinuses

59
Q

Venous system: the ___ ___ arise from the confluence and drain into internal jugular vein

A

transverse sinuses

60
Q

___ ___ ___:
- brief localized loss of brain function
- resolves within 24 hours
- medical emergency due to high likelihood of bigger stroke to happen late (so it is a type of stroke)

A

transient ischemic attack

61
Q

2 types of stroke?

A

infarction, hemorrhage

62
Q

Stroke: infarction: embolus
- where is the clot from?
- timeline for loss of function?

A

Embolus:
- clot from somewhere else
- sudden, quick loss of function

63
Q

Stroke: infarction: thrombus
- where is the clot from?
- timeline for loss of function?

A

thrombus:
- narrowing and/or clot in area involved
- gradual worsening of function (mins to days)

64
Q

___% of all strokes are infarcts

A

80

65
Q

what artery to most strokes affect?

A

middle cerebral artery

66
Q

Stroke: slow occlusion of artery (years) can allow system to develop ____

A

compensations

67
Q

Stroke: small deep circulation infarcts are called what?

A

lacunar infarcts

  • most common in basal ganglia, internal capsule, brainstem and one other place that i dont know
68
Q

Hemorrhage stroke: slow leak or explosive rupture?

A

can be either

  • rupture will cause sudden LOfunction, severe HA, to loss of consciousness
69
Q

Damage from a hemorrhage stroke is due to?

A
  1. downstream loss of blood to brain areas
  2. pressure of extracellular blood accumulating
  3. blood where it is not supposed to be is irritant to brain tissue
70
Q

STROKE: VERTEBRAL ARTERIES:
- prone to what injuries?
- symptoms?

A
  • prone to shear force injuries, esp abrupt cervical rotation or hyperextension with chief symptom of pain
  • symptoms:
    1. gait/limb ataxia/incoordination and weakness
    2. oculomotor and oropharyngeal impairments
    3. numbness
    4. dizziness
    5. HA
    6. vomiting
71
Q

STROKE: BASILAR ARTERIES
- what does complete blockage cause?
- what does partial blockage cause?

A
  • complete blockage causes death due to ischemia of brainstem with vital functions
  • partial blockage can cause:
    1. tetraplegia
    2. numbness
    3. LOC
    4. cranial nerve damage
    example would be locked in syndrome
72
Q

STROKE: ANTERIOR CEREBRAL ARTERY
- what are the symptoms?

A
  • hemiparesis/hemisensory loss to contralateral side (based on homunculus think lower limbs)
  • personality changes (like flat affect and impulsivity, gait apraxia)
73
Q

STROKE: MIDDLE CEREBRAL ARTERY
- symptoms?
- based on each side?

A
  • hemiparesis/hemisensory loss to contralateral side (based on homunuculus think face and upper limb)
  • L side: language
  • R side: spatial relationships, neglect, nonverbal communication
74
Q

STROKE: POSTERIOR CEREBRAL ARTERY
- supplies what?
- symptoms?

A
  • supplies midbrain, diencephalon, hippocampus (declaritive memory), thalamus (pain, contralateral hemiparesis/hemisensory loss)
  • eye movements
  • cortical blindness
75
Q

STROKE: ____ ___
- anastomoses of distal branches of cerebral arteries
- vulnerable to ischemia

A

watershed areas

Neuro (10 decks)

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