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Neuro 1 Exam > 7.1 Craniofascial Vasculature I > Flashcards

7.1 Craniofascial Vasculature I Flashcards

1
Q

What are our cranial meninges?

A
  • 3 layers of dense regular CT that separate the soft tissue of the brain from the bones of the cranium.
  • Roles:
    • CSF circulates
    • Enclose and protect blood vessels that supply vein.
    • Form veins that drain blood.
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2
Q

From superficial to deep, the cranial meninges are:

A

1. Dura mater

  • Periosteal layer
  • —dural venous sinuses—-
  • Meningeal layer

2. Arachnoid mater

  • Subarachnoid space (aka subdural space) contains CSF, which cushions the brain. Small projections of arachnoid mater into the dura (known as arachnoid granulations) allow CSF to re-enter the circulation via the dural venous sinuses.

3. Pia mater

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3
Q

What is located inside the dura mater?

A

Between these periosteal layer and meningeal layer of dura mater, are the dural venous sinuses are located. They are responsible for the venous vasculature of the cranium, draining into the internal jugular veins.

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4
Q

Where do epidural bleeds and subdural bleeds occur?

A
  1. Epidural bleeds: occur outside of dura
  2. Subdural bleeds: occur inside dura
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5
Q

What is the dura mater?

A

Tough (strongest) membrane made up of 2 fibrous layers.

    1. Periosteal layer: attaches to the periosteum of the cranial bones
    1. Meningeal layer

Layers are fused, except where they separate to form large, bloodfilled spaces called dural venous sinuses

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6
Q

What vein runs from the scalp -> dural venous sinus?

A
  • Emissary vein.
  • If injury to scalp: infection can enter dural venous sinus -> meningitis.
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7
Q

What is the arachnoid mater (arachnoid membrane)?

A

Lies below the dura mater and is made up of collagen and elastic fibers, called arachnoid trabeculae.

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8
Q
  • Between the arachnoid and the overlying dura mater is the __________
  • Immediately deep to the arachnoid is the ___________.
A
  • Between the arachnoid and the overlying dura mater is the subdural space.
  • Immediately deep to the arachnoid is the subarachnoid space.

According to Wright, they are the same.

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9
Q

Pia Mater

A

innermost meninges made up of thin layer of CT that adheres to brain and follows every counter of brain surface.

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10
Q

The dura is a fibrous tissue consisting of two layers, an outer periosteal layer and an inner meningeal layer.

What are the cranial dural septa?

A

Meningeal layer of the dura forms septa at 4 locations, called the cranial dural septa that seperate, stabilize and support the brain.

  1. falx cerebri
  2. tentorium cerebelli
  3. falx cerebelli
  4. diaphragma sellae (overlays pituitary fand and helps to form cavernous space)

In these septa, are dural venous sinuses.

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11
Q

What are the 4 dural venous sinuses?

A
  1. inferior sagittal sinuses
  2. straight sinus
  3. sigmoid sinus
  4. transverse sinus
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12
Q

describe cranial dural septa

A
  1. Falx cerebri separates the two cerebral hemispheres
  2. Tentorium cerebelli separates the cerebellum from the occipital lobes. It is fused to the falx cerebri in the midline.
  3. Falx cerebelli is located between to cerebellar hemispshere
  4. Diaphragma sellae forms an incomplete cover over the hypophysis allowing the pituatory stalk/infundibulum
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13
Q

2. Draw venous drainage through the dural venous sinuses.

A
  1. The superior sagittal sinus, inferior sagittal sinuses and straight sinus (continuation of the great cerebral vein and inferior sagittal sinus) are found in the falx cerebri of the dura mater and converge at the confluence of sinuses.
  2. From the confluence, the transverse sinus continues bilaterally and curves into the sigmoid sinus to meet the opening of the internal jugular vein.
  3. The cavernous sinus drains the inferior/superior ophthalmic veins and can be found on either side of the sella turcica. From here, the blood returns to the internal jugular vein via the superior or inferior petrosal sinuses.
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14
Q

What drains into the dural venous sinuses?

A

Blood and CSF from subarachnoid space via arachnoid granulations

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15
Q

Vasculature and innervation of dura mater

A
  • Receives its own vasculature; mainly from the middle meningeal artery and vein.
  • Innervated by: trigeminal nerve (V1, V2 and V3).
    *
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16
Q

Blood supply to meninges: typically concerns blood supply of dura mater.

A
  1. Middle meningeal A. (branch of maxillary. A) -> enters middle cranial fossa via foramen spinosum and divides into:
    • Anterior branch of middle meningeal A
    • Posterior branch of the middle meningeal A.
  2. Smaller roles: vertebral a. and occipital a.
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17
Q

Innervation of meninges

A
  1. CN V (trigeminal)
    • V1- opthalamic n.
    • V2- maxillary n
    • V3- mandibular n.
  2. Floor of posterior cranial fossa
    • Cervical spinal nerves from C2 and C3
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18
Q

What structures are assx with the cavernous sinus?

A
  1. Nerves of the superior orbital fissue (3, 4, V1 and 6)
  2. Internal carotid A.
  3. Infundibulum
  4. V2 and V3.
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19
Q

Thrombosis in cavernous sinus will affect what?

A
  • 3, 4, V1, 6.
  • Mostly, CN6 or ICA because they move free in the blood of cavernous sinus.
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20
Q

Review the cavernous sinus and its clinical relationships with the sphenoidal air sinus, nerves and orbital drainage.

A

The cavernous sinuses lies:

  • lateral to the sphenoidal sinus with all their vessels (internal carotid artery) and cranial nerves (3, 4, V1 and 6).
  • pituitary fossa and the optic chiasm lie above
  • nasopharynx is located below the sphenoidal sinus.
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21
Q

A potential complication of sphenoidal sinusitis is __________

A

cavernous sinus thrombosis.

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22
Q

What is the danger triangle?

A

Along nose and upper lip.

An infection can go to cavernosus sinus cause thrombosis. This can block venous blood flow, and if bad, can block venous blood flow of ICA.

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23
Q

Pituitary masses/aneurysms of the internal carotid can cause what?

A

compress structures in cavernous sinus

24
Q

_____________ is the MOST susceptible to injury in cavernous sinus.

A

ABDUCENS

25
Q

Sx of cavernous sinus thrombosis.

Dx:

Rx:

A
  • Sx: high fever, decreased visual acuity affected eye cant move laterally d/t. CN 6.
  • Dx: CT/MRI
  • Rx: IV ABX
26
Q

What is CSF?

A

Circulates in the ventricles and subarachnoid space, bathing the exposed surfaces of the CNS and completely surrounds it.

Functions:

  • buoyancy
  • protection
  • environmental stability
27
Q

What forms CSF?

A

Choroid plexus in each ventricle. Ependymal cells that originate from the blood plasma, secrete a fluid to make CSF.

28
Q

Is CSF similar to plasma?

A

Is similar to blood plasma but has greater amounts of sodium, hydrogen, and calcium, but less potassium.

29
Q

Drainage of CSF:

A
  • Occurs in the subarachnoid space.
  • Small projections of arachnoid mater (called arachnoid granulations), protrude into the dura mater. They allow the fluid to drain into the dural venous sinus.
30
Q

What happens if we have increased intracranial pressure (high pressure in CSF) or ineffective exchange at arachnoid granulations.

A

Hydrocephalous

31
Q

What drains into DV sinuses? (?)

A
  1. CSF
  2. Emissary vein
  3. Diploic vein
32
Q

The bulk of the venous drainage from the head and neck terminate in the __________ , which join the __________ to form the __________posterior to the medial end of the clavicle

A

The bulk of the venous drainage from the head and neck terminate in the internal jugular vein, which join the subclavian vein to form the brachiocephalic vein posterior to the medial end of the clavicle

33
Q

Internal jugular vein:

Receives blood from:

Path:

A
  • Receives blood from: brain, face and the neck.
  • Path:
    • Comes from signmoid sinus ->
    • emerges through the jugular foramen->
    • descends behind and then lateral to the internal common carotid artery inside the carotid sheath
34
Q

deep cervical lymph nodes in the neck consist mainly of _____ nodes. Why are they important clinically?

A

Collecting

CN importance: potential sites of metastasis from head and neck tumors.

35
Q

What are the levels of the deep cervical LN?

A
  • I Submental and submandibular lymph nodes
  • II -IV Deep cervicaI lymph nodes distributed along the internal jugular vein ( lateral jugular lymph nodes) :
  • II Deep cervical lymph nodes (upper lateral group)
  • III Deep cervical lymph nodes (middle lateral group
  • IV Deep cervical lymph nodes (lower lateral group)
  • V Lymph nodes in the posterior cervical triangle
  • VI Anterior cervical lymph nodes
36
Q

There are two main sites in the neck where the lymphatic pathways intersect. What are they?

A
  1. Jugulofacial venous junction
  2. Jugulo-subclavian venous junction
37
Q

What drains into jugulofacial venous junction?

A

Lymph from head-> redirected vertically downward in the neck.

1. Occipital

2. Parotid-auricular

3. Facial

4. Submental-submandibular

38
Q

What drains into jugulosubclavian venous junction?

A

The main lymphatic trunk, the thoracic duct, terminates at this central location. Collects lymph from left side of the head and neck region is combined with lymph draining from the rest of the body.

1. Nuchal

2. Those parallel to internal jugular vein

3. Those along accessory N/

4. Axillary LN

5. Laryngotracheo thyroidal

39
Q

If only peripheral nodal groups are affected this suggests a localized disease process. If the central groups (junctions), what does this mean?

A

extensive disease.

40
Q

In palpating cervical LN:

What is the order of palpation?

A
  1. Submental/ submandibular LN,
  2. mandibular angle, then proceeds along the
  3. Anterior border of the sternocleidomastoid muscle.
  4. The supraclavicular lymph nodes are palpated next, followed by the lymph nodes along the accessory nerve and the nuchal group of nodes
41
Q

Describe the begining and end of the internal jugular v.

A
  • Begining and end of internal jugular vein has dilations called superior and inferior bulbs.
  • Superior bulb has no valves but inferior bulb has a bicuspid valve, allowing it to open when pressure increases.
42
Q

Inferior petrousal sinus

A
  • Vein that feeds into the internal jugular vein and helps to drain the cavernous. -> jugular foramen -> joins internal jugular vein below superior bulb.
43
Q

Facial vein:

What forms it?

What does it communicate with?

A

Formed by the union of the supraorbital and supratrochlear veins at the medial canthus to form the angular vein.

Communicates with:

    1. Cavernous sinus via superior opthalamic v.
    1. Ptergoid plexus via the deep facial v
44
Q

Path of facial vein

A
  1. Descends on the face posterior to the facial artery to the lower border of the mandible
  2. Joins ptergoid plexus (via deep facial v) and cavernous sinus (via superior opthalamic v.)
  3. Combines with anterior division of the retomandibular vein
45
Q

• Retromandibular vein:

Formed by:

A
  1. Formed by the union of superficial temporal and maxillary vein from the pterygoid plexus
  2. Passes downwards in the substance of the parotid gland
  3. emerging from its lower border & divides into two divisions: anterior and posterior
    1. Anterior division joins facial vein
    2. Posterior division: goes through deep fascia to join the posterior auricular and form the external jugular v.
46
Q

What is the maxillary vein?

A
  1. Short stump that is formed by veins of pterygoid plexus
  2. Goes back between the sphenomandibular ligament and the neck of the mandible
  3. Unite with the superficial temporal vein to form the retromadibular vein
47
Q

• Pterygoid plexus:

A

a network of very small veins located around and within lateral pterygoid muscle in the infratemporal region.

48
Q

Pterygoid plexus drains into what?

A

large, short maxillary veins which join the superficial temporal vein to form the retromandibular vein.

49
Q

How can we drain the pterygoid plexus if the maxillary is occluded?

A

Deep facial vein drain the plexus into the facial vein if the maxillary is occluded

50
Q

________ acts as pump, to help venous return by the pumping action of the muscle every time the mouth is opened.

A

PTERYGOID PLEXUS

51
Q

Yawing is a reflex triggered by ________.

A

venous stagnation

52
Q

Pharyngeal veins:

Drain what:

End in the:

A
  • drain the pharyngeal plexus on the outer surface of the pharynx.
  • End in the internal jugular vein , the facial, lingual or the superior thyroid veins
53
Q

Anterior jugular vein:

A

start below the chin, pass beneath the platysma to the suprasternal notch.

54
Q

External jugular vein: –

A
  • Formed behind the angle of the mandible by the union of the
    • posterior auricular
    • posterior division of the retromandibular veins
  • Descend obliquely, deep to the platysma, receive the posterior external jugular vein
  • Pierce the deep fascia just above the clavicle and drain into the subclavian vein
55
Q

– Tributaries:

A
  1. Posterior auricular vein
  2. posterior division of retro mandibular vein
  3. Posterior external jugular vein
  4. transverse cervical vein
  5. suprascapular vein
  6. anterior jugular vein
56
Q
A

Neuro 1 Exam (24 decks)

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