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M2 NENTE Anatomy > 5.1 Cranium & the brain > Flashcards

5.1 Cranium & the brain Flashcards

1
Q

The cranial sutures are _______ joints (synarthroses) of the bones of the vault or face:
• ___________ are membranous areas in the cranial vault which have not ossified yet, and allow for rapid stretching and deformation of the cranium (for developing brain)

A

fibrous;

Fontanelles

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2
Q

Where is the coronal suture?

A

between frontal and parietal bones?

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3
Q

where is the sagittal suture?

A

between parietal bones?

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4
Q

where is the lambdoid suture?

A

between parietal and occipital bones

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5
Q

where is the pterion (in temporal fossa?

A

H-shaped junction between the frontal, parietal, temporal and sphenoid bones

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6
Q

Pterion fractures: the pterion is the weakest part of the skull and is easily fractured
- Direct traumatic blow (to the pterion) or indirect blows to the top or back of the skull may place sufficient force on the skull to fracture the pterion
• ______________ runs immediately deep to the pterion traumatic blows/fractures may rupture the artery (life-threatening significant epidural haematoma).

A

Anterior division of the middle meningeal artery

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7
Q

What are the 5 layers of the scalp?

A 
Skin 
Connective tissue 
Aponeurosis 
Loose areolar tissue
Pericranium
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8
Q

What does the skin of the scalp contain?

A

Contains sebaceous glands and hair follicles (head hair)

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9
Q

What does the connective tissue of the scalp contain?

A

Dense subcutaneous layer of fat and fibrous tissue containing the nerves and blood vessels of the scalp

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10
Q

Where does the aponeurosis of the scalp run?

A

Epicranial aponeurosis (galea aponeurotica) is a layer of dense fibrous tissue running from the frontalis muscle to occipitalis

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11
Q

what is the loose areolar tissue of the scalp made up of?

A

Made of type I and III collagen bundles and glycosaminoglycans (allows more superficial layers to shift about over the pericranium):
• Danger zone: infections may spread easily via emissary veins into the cranium

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12
Q

Pericranium of the scalp: Periosteum of the skull bones (provides nutrition and capacity for repair to the bones) → continuous with __________ at suture lines

A

endosteum

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13
Q

Scalp lacerations: deep lace rations to the scalp tend to bleed profusely (due to pull of _______________ preventing closure of vessel and skin, adherence of vessels to dense connective tissue preventing vasoconstriction, numerous anastomoses
- Loss of blood supply to the scalp does not cause bone necrosis (most arterial supply to skull is from the _________________)

A

occipitofrontalis muscle;

middle meningeal artery

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14
Q

what does the anterior cranial fossa contain?

A

Frontal lobe of the cerebral hemispheres

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15
Q

What does the middle cranial fossa contain?

A

Temporal lobes of the cerebral hemispheres

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16
Q

What does the posterior cranial fossa contain?

A

Cerebellum, pons, medulla oblongata (hindbrain)

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17
Q

[anterior cranial fossa]
perforations in cribiform plate
- bone
- structures

A
  • ethmoid bone

- CN1

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18
Q

[middle cranial fossa]
optic canal
- bone
- structures

A
  • lesser wing of sphenoid

- CNII, opthalmic artery

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19
Q

[middle cranial fossa]
superior orbital fissure
- bone
- structures

A
  • between lesser and greater wings of sphenoid
  • CN III, IV, V1 (ophthalmic), VI
  • Lacrimal, frontal, nasociliary nerves (V1)
  • Superior ophthalmic vein
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20
Q

[middle cranial fossa]
foramen rotundum
- bone
- structures

A
  • greater wing of sphenoid

- CNV2 (maxillary)

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21
Q

[middle cranial fossa]
foramen ovale
- bone
- structures

A
  • greater wing of sphenoid

- CNV3 (mandibular)

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22
Q

[middle cranial fossa]
foramen spinosum
- bone
- structures

A
  • greater wing of sphenoid
  • Meningeal branch of CN V3
  • Middle meningeal artery
23
Q

[middle cranial fossa]
carotid canal + foramen lacerum
- bone
- structures

A
  • Between petrous part of temporal and sphenoid
  • The foramen lacerum is normally closed in a living person, and the carotid canal is its continuation.
  • ICA at the carotid canal
24
Q

[posterior cranial fossa]
internal acoustic meatus
- bone
- structures

A
  • Petrous temporal

- CN7+8

25
Q

[posterior cranial fossa]
jugular foramen
- bone
- structures

A
  • Between petrous part of temporal and condylar part of occipital bone
  • CN 9. 10. 11
  • IJV
26
Q

[posterior cranial fossa]
hypoglossal canal
- bone
- structures

A
  • occipital bone

- CN12

27
Q

[posterior cranial fossa]
foramen magnum
- bone
- structures

A
  • occipital bone
  • Medulla oblongata
  • Spinal part of CN XI
  • Right and left vertebral arteries
28
Q

where is the falx cerebri located?

A

Sickle-shaped fold; lies in midline between cerebral hemispheres

29
Q

where is the tentorium cerebelli?

A

Crescent fold; roofs over the posterior cranial fossa (separates cerebellum from the occipital lobes)

30
Q

where is falx cerebrelli located?

A

Small sickle-shaped fold; attached to the internal occipital crest and projects forward between the 2 cerebellar hemispheres

31
Q

where is a diaphragma sellae?

A

Small circular fold; roofs over the sella turcica (pituitary fossa)

32
Q

DURAL VENOUS SINUSES The dural venous sinuses lie between the _________________ mater, and drain the CNS, face, and scalp:
• Drain into the internal jugular veins (IJVs); do not possess valves (unlike other veins)
• Eleven venous sinuses which include the straight, superior, and inferior sagittal sinuses (in ____________), transverse sinus, sigmoid sinus and cavernous sinus:
o Straight sagittal sinus is a continuation of the _________________

A

periosteal and meningeal layers of dura;

falx cerebri;

great sagittal vein and inferior sagittal sinus

33
Q

Cerebral venous sinus thrombosis (CVST): presence of thrombus within one of the dural venous sinuses, which occludes venous return and causes accumulation of deoxygenated blood in the brain parenchyma –> venous infarction

  • May be complicated by _______________ –> unable to drain through the thrombosed venous sinuses
  • Common clinical features headache, nausea and vomiting, neurological deficits
  • Treatment: anticoagulant drugs
A

accumulation of CSF (hydrocephalus)

34
Q

CSF CIRCULATION
CSF is produced by the _____________ in the lateral, third and fourth ventricles (via filtration of blood and modification of filtrate by reabsorption and secretion):
• Flows from lateral ventricles to 3rd ventricle via __________________
• 3rd and 4th ventricles are connected via the cerebral aqueduct (of Sylvius)
• Flows from 4th ventricle into the subarachnoid space via the lateral apertures (______________) and the median aperture (_______________):
o Foramina of Luschka drain CSF into the ___________________
o Foramen of Magendie drains CSF into the _____________
• Absorption of CSF back into the bloodstream occurs in the superior sagittal sinus via the __________ (push through arachnoid mater)

A

epithelial cells of the choroid plexus;

interventricular foramen (of Monro);

foramina of Luschka;

foramen of Magendie;

cerebellopontine angle cistern;

cisterna magna;

arachnoid villi

35
Q

Hydrocephalus: accumulation of CSF within the ___________________, causing increased intracranial pressure and brain herniation/compression (abnormal function)

Head enlargement due to hydrocephalus occurs only in ______________________

  • Most common congenital cause is ___________ (other causes include neural tube defects, arachnoid cysts, Arnold Chiari malformation)
  • Associated with _________ (meningocele –> Arnold Chiari malformation –> increased cranial CSF production + uncal herniation –> hydrocephalus)
  • Management: insertion of cerebral shunt system into the dural venous sinus (lies under the anterior fontanelle ) –> shunt must be changed as the person grows
A

ventricular system and CSF spaces;

children whose anterior fontanelle (soft spot) has not fused (before 6 months);

aqueductal stenosis;

spina bifida

36
Q

What does the diencephalon contain?

A

Consists of the thalamus, hypothalamus, epithalamus (pineal gland) and subthalamus (functionally part of the basal ganglia)

37
Q

What does the midbrain contain?

A

Connects the forebrain with the hindbrain (with cerebral aqueduct down the middle); consists of the cerebral peduncles (2 halves), substantia nigra, red nuclei and other important brainstem structures

38
Q

What does the hindbrain contain?

A

Consists of the pons, medulla oblongata and cerebellum

39
Q

What does the ventral midbrain contain?

A

crus cerebri (peduncles), CN III

40
Q

What does the dorsal midbrain contain?

A

superior & inferior colliculi, CN IV

41
Q

What does the ventral pons contain?

A

basilar sulcus (and basilar artery), CN V, VI, VII, VIII

42
Q

What does the posterior pons contain?

A

superior, middle & inferior cerebellar peduncles, floor of 4th ventricle

43
Q

What does the ventral medulla contain?

A

anterior median fissure, anterolateral sulcus, pyramids, olives, CN IX, X, XI, XII

44
Q

what does the dorsal medulla contain?

A

posterior median sulcus, posterolateral sulcus, median sulcus, sulcus limitans, hypoglossal trigone, vagal trigone, area postrema, obex

45
Q

The brain receives its arterial supply from the vertebral arteries (from ___________) and internal carotid arteries (ICA) which are connected in the ____________:
• Meninges are supplied by the anterior, middle, posterior meningeal arteries
• Venous drainage: cerebral veins → dural venous sinuses → internal jugular veins (IJV)

What are the branches of the internal carotid arteries and vertebral arteries? ?

A

subclavian arteries;

circle of Willis;

ICA: anterior cerebral, anterior communicating, middle cerebral;

vertebral: basilar, posterior cerebral; posterior communicating, anterior inferior cerebellar artery, posterior cerebellary artery, anterior spinal artery

46
Q

Extradural haemorrhage

  • injuries to the _______ (run in the epidural space)
  • __________ lesion
  • limited by suture lines
  • midline shift (less)
  • loss of consciousness –> lucid interval –> sudden detoriation (vomiting, restlessness, loss of consciousness)
A

meningeal arteries;

bioconvex

47
Q

subdural haemorrhage

  • Tearing of ______________ at point of entry to superior sagittal sinus
  • __________ lesion
  • Not limited by suture lines
  • Midline shift
  • Gradually increasing headache and confusion (slower onset)
A

superior cerebral veins (or bridging veins);

Concave (crescent-shaped)

48
Q

Subarachnoid haemorrhage

  • Leakage or rupture of congenital aneurysm on the ____________ (85%)
  • Extends into ________ (CSF spaces)
  • Not limited by suture lines
  • Diagnosed by lumbar puncture (check for ______________)
  • Sudden onset of severe headache (____________ headache)
A

circle of Willis;

sulci;

RBC count and xanthochromia;

thunderclap

49
Q

The Monro-Kellie doctrine describes the pressure-volume relationship between intracranial pressure (ICP), volume of CSF, blood, brain tissue and cerebral perfusion pressure (CPP):
Vintracranial = __________+_______+________
• A dynamic equilibrium exists between the non-compressible components of the brain within the rigid compartment of the skull
• Increase in volume of one cranial component must be compensated by a decrease in the volume of another (main buffers of increased volumes are _________________)
• Signs & symptoms of increased ICP: headache (typically morning), vomiting (without nausea), ocular palsies, altered consciousness, back pain, papilloedema etc.
o Differ in children as their fontanelles have not fused (bulge out with high ICP)

A

Vbrain + Vblood + VCSF;

CSF and blood

50
Q

What is the mechanism of uncal hernia?

A

Medial temporal lobe (uncus) pushes downward into the posterior cranial fossa through the tentorial incisura

51
Q

What is the mechanism of central hernia?

A

Downward displacement of the cerebral hemisphere and basal nuclei (ganglia) through the tentorial notch

52
Q

What is the mechanism of subfalcine hernia?

A

Brain tissue extending under the falx in the supratentorial cerebrum

53
Q

What is the mechanism of tonsillar hernia?

A

Cerebellar tonsils protruding below the foramen magnum (compresses medulla and upper cervical spinal cord)

M2 NENTE Anatomy (24 decks)

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