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SKULL/CRANIAL ANATOMY & TRAUMA > ALL THE THINGS > Flashcards

ALL THE THINGS Flashcards

1
Q

What 2 skulls do humans have?

A

neural skull

facial skull

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2
Q

What does the neural skull do for the brain?

A

it provides protection

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3
Q

What does the facial skull do?

A

provides support for the teeth, attachment of muscles, etc.

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4
Q

Which skull predominates in the fetus and neonate?

A

the neural skull predominates

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5
Q

Are the bones of the fetal neurocranium fused?

A

NO

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6
Q

What are the intervening spaces of the fetal neurocranium filled with?

A

fibrous membranes

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7
Q

What are Fontanelles?

A

Larger intervening spaces

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8
Q

What are the main fontanelles?

A

anterior
sphenoidal
mastoid

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9
Q

What is the anterior fontanelle?

A

separates the single frontal and two parietal bones

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10
Q

What is the sphenoidal fontanelles?

A

occupies the area between the sphenoid, parietal, temporal, and frontal bones

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11
Q

What is the mastoid fontanelle?

A

area between the temporal, occipital, and parietal

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12
Q

What is something normal that the fontanelles do that may seem abnormal?

A

pulsate

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13
Q

What is indicative of fontanelle pathology?

A

deformations such as a bulge or depression

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14
Q

What are the fontanelle’s replaced by?

A

sutures

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15
Q

What are the sutures of the skull?

A

Sagittal suture (separates left and right parietal bones)

Coronal suture

Lambdoid suture (separates the occipital bone from the parietal and temporal lobes)

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16
Q

What is premature closure of the fontanelles or sutures called and what does it lead to?

A

craniosynostosis

leads to cranio-facial abnormalities like Crouzon syndrome

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17
Q

How many bones make up the neural skull?

A

8 bones!

2 parietal
2 temporal
1 frontal
1 occipital
1 sphenoid
1 ethmoid
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18
Q

How many bones make up the facial skull?

A

14 bones!

2 maxillae (upper jaw)
2 palatine bones (associated with palate)
2 nasal bones
2 inferior conchae
2 zygomatic bones
2 lacrimal bones (tears)
1 vomer
1 mandible (lower jaw)
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19
Q

What are the important foramina of the skull?

A

superior orbital foramen
superior orbital fissure
infraorbital foramen
mental foramen (chin)

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20
Q

What prominent features are seen from the posterior view of the skull?

A

sutures

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21
Q

What are Womian Bones?

A

seen on X-rays as fractures

Associated with Down Syndrome and Brittle Bone syndrome

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22
Q

What is the interior of the skull divided into?

A

3 fossae that contain regions of the brain as well as the foramina and fissueres that serve as exits from the cranial vault for nerves and vessels

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23
Q

What are the fossae of the skull?

A

anterior
middle
posterior

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24
Q

What is significant about the anterior fossa?

A

contains the anterior and inferior parts of the frontal lobes

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25
Q

What forms the anterior fossa?

A

orbital plate

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26
Q

What is significant about the middle fossa?

A

butter fly shaped

supports the temporal lobes of the brain and serves to anchor the tentorial fold. Also contains the Sella turcica

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27
Q

Where does the middle fossa extend?

A

from the crests of the sphenoid bone anteriorly, the greater wings of the sphenoid, and the squamous parts of the temporal bones laterally, and the petrous portion of the temporal bones posteriorly.

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28
Q

What is the sella turcica?

A

“Turkish saddle”

houses the pituitary gland and many passages for nerves and vessels.

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29
Q

Where does the posterior fossa end?

A

it ends at the Foramen magnum

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30
Q

What is significant about the posterior fossa?

A

largest and deepest of the 3 fossa

houses the cerebellum, pons and medulla

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31
Q

How far does the sphenoid bone stretch?

A

all the way across the cranial fossae (left to right)

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32
Q

What are the points of attachment of the dura mater?

A

crista galli
clinoid processes

petrous portions of the temportal bone

internal occipital ridge

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33
Q

The crista galli is a projection of what?

A

the ethmoid bone

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34
Q

Where are the clinoid processes found?

A

on the sphenoid bone

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35
Q

Where are the petrous bridges found?

A

temporal bones

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36
Q

Why is the basal view of the skull the most complex?

A

has many foramina

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37
Q

What injury is common with people sustaining blunt head trauma?

A

skull base fractures that vary in severity depending on which foramina are affected

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38
Q

What is the Pterion?

A

a landmark that defines the union of 4 bones:

patietal
frontal
sphenoid
squamous part of temporal

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39
Q

Besides the scalp, what else offers protection to the brain?

A

2 lamina

meninges - Dura mater, arachnoid space, pia mater

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40
Q

What is the Dura Proper?

A

it is the inner layer of Dura that is flush with the dura mater of the spinal cord

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41
Q

What is the outer layer of the skull called?

A

periosteum

42
Q

What restrains movement of the brain?

A

dural folds

43
Q

What does the cranial dura split into?

A

dural sinues containing venous blood

44
Q

What are the most importan dural folds?

A

falx cerebri

tentorium cerebeli

45
Q

What does the falx cerebri do?

A

along with the tentorium, prevents the brain from moving side to side

46
Q

What is the origin of the falx?

A

from the crista galli

47
Q

What does the falx form?

A

the folds between hemispheres

48
Q

What do the petrous ridge and the clinoid process form?

A

the “tent” where the brain stem comes through

49
Q

What is the other smaller dural fold?

A

dorsum sellae; covers the pituitary fossa

50
Q

What are the 3 important sites of vulnerability for the brain?

A

epidural space
sub-dural space
arachnoid granulations

51
Q

Why is the epidural space vulnerable?

A

fractures of the skull can lead to this becoming a real space filled with blood

52
Q

Why is the sub-dural space a vulnerable area?

A

major sub arachnoid veins must traverse this space to access the superior sagittal sinus and are vulnerable to tearing

53
Q

Why are the arachnoid granules vulnerable?

A

CSF exits here

high venous pressure can block the exit of CS and caus ventricles to expand

54
Q

What is the weakest point of the skull and why?

A

pterion

skull is thinnest here

55
Q

What can cause an epidural hematoma to occur?

A

if one or both lamina of the skull is fractured such that the dura is torn in the region occupied by a meningeal artery, the vessel will rupture and arterial blood will fill up the space

56
Q

What happens when blood accumulates in the epidural space?

A

blood forms a focalized swelling that displaces the brain

57
Q

How is the trauma of an epidural hematoma judged?

A

by the level of consciousness

alert
stupor
partial coma
deep coma

58
Q

What does an epidural hematoma look like on a CT?

A

presents with a lenticular shape

59
Q

What can happen if displacement due to epidural hematomas is severe?

A

the temporal lobe can herniate over the tentorium over the brainstem compressing CN III

60
Q

A severe case of epidural hematoma causing severe displacement can present with what symptoms?

A

occulomotor palsies
pupillary dilation
ptosis (drooping eyelid)

disruption of the cortico spinal tract leading to motor deficits

61
Q

What kind of pressure is involved in causing an epidural hematoma?

A

arterial pressure

62
Q

What will cause a subdural hematoma?

A

if trauma causes a shear fore that damages a vein as it traverses this space, venous blood will accumulate in the space

63
Q

How does a subdural hematoma appear on a CT?

A

bright

64
Q

The extent of a subdural hematoma is determined by what?

A

venous pressure; injury can continue to progress long after initial trauma

65
Q

As a subdural hematoma becomes more chronic, how does it appear on a CT?

A

more opaque

66
Q

What syndromes are subdural hematomas often associated with?

A

shaken baby syndrome

“roller coaster syndrome”

67
Q

What is a contusion?

A

tear in the fabric of the brain that damages blood vessels, glial cells and neurons and usually leads to motor and sensory deficits

68
Q

What kind of Parkinson’s can a contusion cause?

A

trauma-induced Parkinson’s

69
Q

How do contusions appear overtime?

A

calcified

70
Q

What are concussions?

A

blows to the head that result in brief dizziness, disorientation, and sometimes periods of unconsciousness

71
Q

Multiple minor concussions can lead to what?

A

they can have a cumulative effect and can cause Chronic traumatic encephalopathy (CTM)

72
Q

In order to assess head trauma, what scale do we use?

A

The Glasgow Scale

73
Q

What is one PARTICULARLY serious consequence of head trauma?

A

CSF leakage

74
Q

What is the source of CSF?

A

ventricular system

75
Q

What connects the 3rd ventricle to the 4th ventricle?

A

the Iter

76
Q

What is another name for the Iter?

A

cerebral aqueduct of Sylvius

77
Q

Where is CSF formed?

A

choroid plexuses in each ventricle

78
Q

What path does CSF take to get to the subarachnoid space?

A

lateral ventricles —> foramina of Monroe —> 3rd ventricle —> Iter —> 4th ventricle —> foramina of Luschka and Magendie

79
Q

What is the volume of the sub-arachnoid space?

A

150 mL

80
Q

How much CSF is produced each day?

A

300 mL

81
Q

Blockage of the Iter will cause what?

A

CSF build up in the lateral and 3rd ventricles resulting in Hydrocephalus

82
Q

What causes congenital hydrocephaly?

A

infections in the mother during pregnancy (chicken pox, etc.)

83
Q

What causes acquired hydrocephaly?

A

injury, brain tumor, infections, etc.

84
Q

What is compressed in a hydrocephalic patient?

A

thalamus, basal ganglia, internal capsul

85
Q

How would you treat a hydrocephalic patient?

A

by inserting a shunt that passes the CSF from the ventricles to the venous system

86
Q

What is Pneumocephalus?

A

a fracture of the frontal sinus that allows the CSF to escape through the nose

87
Q

How many venous systems are there?

A

emissary veins
diploic veins
venous sinuses
veins of the subarachnoid space

These are all interconnected

88
Q

What are the venous systems continuous with?

A

capillary networks in the pia mater that receive blood from the brain

89
Q

Where do the superior/inferior cerebral veins drain and where do they merge?

A

superior/inferior sagittal sinuses

(INFERIOR ONLY)

  • –> Great vein of Galen
  • –> straight sinus

Merge at the confluens of the sinuses in the occipital region

90
Q

Where does blood in the venous sinuses ultimately exit?

A

the internal jugular veins

91
Q

Increased venous pressure in the superior sagittal sinus can do what?

A

prevent the arachnoid granulations from opening that will result in increased pressure in the ventricular system

92
Q

Why is the Cavernous sinus clinically significant?

A

the facial, angular, and opthalmic vein are all connected to the region of the cavernous sinus

infections adjacent to the nose can spread to the sinus easily and they are tough to treat

pituitary tumors can also interfere with blood flow here

93
Q

Weakening of the internal carotid artery with formation of an aneurism in the cavernous can lead to what?

A

the aneurysm can bust, changing the blood pressure in the sinus to arterial

this will cause pulsating exopthalmos

94
Q

What is pulsating exopthalmos?

A

swelling of the opthalmic veins in the orbit

95
Q

What are some symptoms/signs of pulsating exopthalmos?

A

protruding eyeball that retracts with heartbeat

detectable pulse in the orbit that can be blocked by carotid compression

Bruit (blood flow) can be detected via stethoscope

96
Q

What are the 2 types of hemorrhagic strokes?

A

intracerebral (within the brain)

subarachnoid

97
Q

What causes a hemorrhagic stroke?

A

a weakened vessel ruptures and bleeds into the surrounding brain

occurs at either an aneurysm or an arteriovenous malformation (AVM)

98
Q

Where are the striate arteries?

A

first branches of the middle cerebral artery

99
Q

What will cause a classic stroke?

A

embolism dislodges from thrombosis in the carotid artery to pass upward to block the striate arteries

resultant ischemia will damage axons passing through the internal capsul thus causing a paralysis and loss of sensation contralaterally

100
Q

What are the common sites for aneurysms at the circle of Willis?

A

Anterior communicating artery

Bifurcation of the internal carotid & Posterior communicating artery

Bifurcation of middle cerebral artery

Basilar artery bifurcation

Remaining posterior circulation arteries

SKULL/CRANIAL ANATOMY & TRAUMA (1 decks)

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