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Block 3 > Anatomy > Flashcards

Anatomy Flashcards

0
Q

At what days does the neural tube close?

A

Day 24-25

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1
Q

What folds to form the neural tube?

A

Neural ectoderm

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2
Q

Describe how the adult brain forms from 3 primary vesicles and then five secondary vesicles

A

1º Brain Vesicles (x3) Prosencephalon, Mesencephalon, Rhombencephalon
2º Brain Vesicles (x5) Telencephalon (hemispheres), Diencephalon (thalamus, Central), Mesencephalon (midbrain), Metencephalon (pons), Myelencephalon (medulla)

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3
Q

What makes up the CNS?

A

Brain, spinal cord, retina & CNII

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4
Q

What are the 3 branches of the motor efferent pathway?

A

Somatic motor
Brachio motor - pharyngeal arch muscles, cranial nerves
Visceral/autonomic motor

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5
Q

What are 3 branches of the sensory afferent pathway?

A

Somatic sensory
Visceral sensory
Special visceral sensory - taste

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6
Q

What are the 3 meningeal layers in the CNS?

A

Dura: Periosteal layer - Thick, fibrous and leathery
Dura: Meningeal layer
Arachnoid mater - Thin and web/lace-like
Pia mater - Thin & adherent to cortex

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7
Q

Where do you find CSF in the CNS?

A

Sub arachnoid space

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8
Q

What is the falx cerebri?

A

Double-layered inward projecting fold of dura in sagittal plane
Prevents left and right cerebral hemispheres from spinning during axial head rotation

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9
Q

What is the Tentorium cerebelli?

A

Double-layered inward projecting fold of dura

Prevents occipital lobe compressing the cerebellum especially during flexion & extension

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10
Q

What is the Falx cerebelli?

A

Double-layered inward projecting fold of dura

Prevents left and right cerebellar hemispheres from rotating

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11
Q

What is the Diaphragm Sellae?

A

Double layered fold of dura

Forms protective pocket for pituitary

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12
Q

Where does blood from the CNS drain?

A

Dural venous sinuses located between two layers of dura

Sinuses are valveless & endothelial lined

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13
Q

Name the venous sinuses

A 
Superior sagittal sinus 
Inferior sagittal sinus 
Straight sinus 
Transverse sinus 
Sigmoid sinus 
Right cavernous sinus
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14
Q

What can blockage of venous sinus drainage cause?

A

Cerebral infarction

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15
Q

Which arteries anastamose to form the circle of Willis?

A

Internal carotid

Vertebral artery

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16
Q

What separates the cerebral hemispheres?

A

Longitudinal fissure

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17
Q

What separates the frontal and temporal lobes?

A

Lateral/Sylvian fissure

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18
Q

What structure connects the cerebral hemispheres?

A

Corpus callosum

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19
Q

Name the cranial nerves

A 
1 olfactory
2 optic
3 occulomotor 
4 trochlear
5 trigeminal
6 abducens 
7 facial
8 vestibulocochlear 
9 glossopharyngeal 
10 vagus
11 accessory 
12 hypoglossal
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20
Q

Describe where the cranial nerves emerge

A 
CN III & IV: Midbrain 
CN V: Pons 
CN VI –VIII: Pontomedullary junction 
CN IX & X: Lateral medulla 
CN XI: C1-C5 spinal cord 
CN XII: Ventral medulla
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21
Q

Where and what are the Cerebral peduncles?

A

Anterior Midbrain

Axons to and from cerebral hemispheres

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22
Q

Which is the only cranial nerve visible posteriorly?

A

CN IV - trochlear

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23
Q

What and where are the superior and inferior colliculi?

A

Posterior midbrain
Superior - linked to visual
Inferior - linked to auditory

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24
Q

Where do Cranial nerves exit the cranium?

A

Foramen magnum in the skull base

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25
Q

What will result from dysfunction of the cerebellum?

A

ataxia, wide-based gate, slurred speech, imbalance, nystagmus

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26
Q

What are the main functions of the cerebellum?

A

Coordination of motor activity
Involved in stabilisation of body (trunk & limbs), memory, cognitive functioning, language processing, logical reasoning
Automates many processes e.g. motor skills, language
Predicts sensory consequence of movements by comparison to previous experience
Frees cerebral cortex for higher level functions

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27
Q

What are the 3 main lobes of the cerebellum?

A

Anterior
Posterior
Flocculonodular

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28
Q

What are the ventricles?

A

Cerebrospinal fluid filled chambers within the subcortical regions of the
brain. Associated with many nuclei. And functional regions of the brain.
Produce CSF via choroid plexus

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29
Q

What are nuclei?

A

Collections of neuronal cell bodies with similar functions and projections. Normally found in subcortical areas at points of synapse

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30
Q

What are Brodmann areas?

A

Cerebral cortex is arranged into regions with specified functions Brodmann classification is based on cyto-architectural/histological structure of the cortex

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31
Q

Where is the primary auditory cortex?

A

Temporal lobe

Brodmann area 41

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32
Q

Where is the primary visual cortex?

A

Occipital lobe

Brodmann area 17

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33
Q

Where is the primary somatosensory cortex?

A

Parietal cortex, post central gyrus

Brodmann area 1

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34
Q

Where is the primary motor cortex?

A

Frontal lobe, pre Central gyrus

Brodmann area 4

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35
Q

Which side of the cortex looks after speech, writing and language?

A

Left

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36
Q

Which side of the cortex looks after special perception and facial recognition?

A

Right

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37
Q

What is synaesthesia?

A

combination of senses that provides an unusual interpretation
Eg See colour, shapes, textures when hearing sound or words, Experience taste when reading numbers

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38
Q

What is Prosopagnosia?

A

inability to recognise faces

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39
Q

What are commisural fibres?

A

White matter structures that connect hemispheres

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40
Q

What are association fibres?

A

Connect regions within the same hemisphere

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41
Q

What are projection fibres?

A

Connect each region to other parts of the brain or the spinal cord

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42
Q

What is Brocas area?

A

Motor planning involved in speech in frontal lobe

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43
Q

What is a Fasciculus?

A

Bundle of fibres sharing a similar function and route of travel

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44
Q

What is Wernickes area?

A

Understanding/interpreting heard, spoken and written word

In termporal lobe

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45
Q

What connects Wernickes area and Broca’s area?

A

Arcuate Fasciculus

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46
Q

What is a Jeffersons fracture?

A

Fracture of anterior and posterior arches of C1 vertebra

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47
Q

What are advantages and disadvantages of xrays?

A

Fast, Cheap, Good bone detail, Dynamic images

2-D, Poor soft tissue detail, X-ray dose

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48
Q

What are advantages and disadvantages of ultrasound?

A

Fast, Cheap, Dynamic images, No radiation

2-D, Poor soft tissue detail, Operator dependent

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49
Q

What role does CT imaging play?

A

A + E, Trauma - haematomas + fractures, Stroke - haemorrhage, Severe headache - SAH, meningitis, Unconscious patient, Hydrocephalus, CT guided biopsies

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50
Q

Describe CT - intravenous contrast

A

Iodine based injection to highlight pathology and increase contrast
Hot flush and odd taste
Appears white on CT
Vessels, pituitary + choroid plexus normally enhance
Other enhancement indicates leaky BBB
1/40,000 anaphylaxis: give asthmatics steroid cover

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51
Q

What pathologies can be seen more easily with CT contrast?

A

Cerebral abscesses

Tumour - glioma

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52
Q

What are advantages and disadvantages of CT?

A

Excellent bone detail, Good for blood + Ca, Good soft tissue detail, Quiet and spacious, CT guided biopsy, 3-D,
Expensive, Very high X-ray dose

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53
Q

In MRI T1 and T2 assessments, what colour is the CSF?

A

T1 - black

T2 - White

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54
Q

What is gadolinium?

A

Contrast medium used in MRI

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55
Q

What are advantages and disadvantages of MRI?

A

No X-rays, Exquisite anatomy, Excellent soft tissue detail, Multiplanar acquisition
Slow, Expensive, Claustrophobic + noisy, Poor bone detail, Contraindications: Metal implants and foreign bodies, pacemakers

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56
Q

Before being scanned in MRI, patients need to complete a screening questionnaire. Objects to be particularly wary of are…?

A

Cardiac pacemakers:- some are electrically or magnetically activated (possible death), pacing wires can cause burns
Aneurysm clips:- if ferromagnetic can move causing re-bleed and death
Electronic implants:- magnetic can reset or destroy
Metal in eye:- can move severing optic nerve

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57
Q

What is the role of digital subtraction angiography?

A

Gold standard for intracranial haemorrhage, aneurysm, arterio-venous malformation / fistula, Assessment of carotid stenosis, Embolisation

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58
Q

What can be a risk of a pituitary tumour?

A

Compression of optic nerve

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59
Q

Which artery do you find in the Sylvian fissure?

A

Middle cerebral artery

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60
Q

What is diffusion weighted MRI imaging useful for?

A

Infarct, Abscess, Cyst, Tumour, Prion disease

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61
Q

Describe a subdural haematoma

A 
Contracoup - occurs on opposite side to area of injury 
Crescentric and thin 
Can cross sutures except sagittal 
Do not cross tentorium 
Flattens the sulci 
Mass effect
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62
Q

Describe and extradural haematoma

A 
Coup - at site of injury 
Concentric 
Do not cross sutures 
Can cross tentorium 
Often underlying fracture 
Often contralateral subdural 
Poor prognosis:  > 2cm, central lucency, > 1.5cm midline shift
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63
Q

Describe a haemorrhagic contusion

A

Mild: limited to grey matter
Moderate: involves white matter
Severe: haemorrhages coalesce
Haemorrhage may be delayed

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64
Q

Where can herniation occur?

A

Uncal/transtentorial
Tonsillar
Subfalcine

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65
Q

What is functional MRI?

A 
Uses different paramagnetic properties of oxygenated and deoxygenated Hb 
Is a measure of cortical brain activity 
Can be combined with an EEG  
Pre surgical planning 
Research tool
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66
Q

What can a DAT scan be used for?

A

Parkinson’s disease diagnosis

SPECT images of brain, particularly the striatum

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67
Q

What is MR spectroscopy used for?

A

Provides information on biochemical and metabolic composition of tissues
Good for tumour - Glioma vs other mass lesion, Tuberculoma, Leukodystrophies

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68
Q

What is the lateral geniculate body of the thalamus?

A

Relay for optic tract fibers

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69
Q

What is the medial geniculate body of the thalamus?

A

Relay for auditory pathway fibres

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70
Q

What is the ventral posterior nucleus of the thalamus?

A

Ventral Posterior Lateral nucleus - Body
Ventral Posterior Medial nucleus - Face – CN V
Sensory relay nucleus of multiple modalities from body & face (touch, pain, temperature, taste). Input from spinothalamic tract, medial lemniscus & trigeminothalamic tracts

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71
Q

What symptoms can damage to the thalamus cause?

A

Contralateral motor & sensory functions
Contralateral part of visual field of each eye
Effects on memory, emotion & mood
Certain lesions can cause pain (thalamic syndrome)

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72
Q

Which cranial nerve emerges from the dorsal midbrain and decussates?

A

Trochlear - IV

73
Q

Which cranial nerves could be compressed by a 4th ventricle tumour?

A

CN VI nucleus and VII wound around

74
Q

Where does most nociception from CN VII, IX, X pass?

A

Via CN V sensory nucleus

75
Q

Describe cortical connections to brainstem motor nuclei and the exceptions to the normal pattern

A

Bilateral supply from the motor cortex
Innervation from corticobulbar/corticonuclear neurons
The majority of UMN innervation comes from contralateral cortex
Cerebral cortex infarction causes an initial contralateral weakness/paralysis that can recover with time due to ipsilateral supply
Exception - Unilateral supply to CN VII nucleus for lower face
And CN III, IV & VI – have a different innervation pattern

76
Q

Describe the process of forehead sparing in some facial nerve lesions

A

CN VII Nucleus receives bilateral & unilateral innervation from the cortex
Forehead part of the nucleus receives bilateral UMN innervation
Lower face part receives only contralateral UMN innervation
UMN lesion results in paralysis of the contralateral lower face with forehead sparing due to ipsilateral supply

77
Q

What is a bulbar palsy?

A

Lower motor neurone lesion affecting CN VII - XII
Paralysis of pharynx, soft palate, larynx, tongue (sometimes face & mastication)
Dysarthria, dysphonia, drooling, poor swallowing, aspiration
Flaccid paralysis, wasting, fasciculations
Causes = Polio, radiotherapy, CVE

78
Q

What is pseudo bulbar palsy?

A

Bilateral corticobulbar tract disorder (upper motor neurone lesion)
Presents initially as LMN lesion
Bilateral damage is clinically significant
Similar symptoms to bulbar palsy but can develop spastic paralysis of
pharynx & larynx = airway occlusion emergency
Causes = Head injury, CVE, high brainstem tumour

79
Q

Describe the vertebrobasilar arterial system

A

Vertebral arteries combine to form basilar artery along with anterior spinal artery
Basilar gives off pontine branches and superior cerebellar
Then posterior cerebral artery and posterior communicating

80
Q

Aneurysm of which artery could compress cranial nerves 3 and 4?

A

Superior cerebellar artery

81
Q

Which cranial nerves are supplied by the PICA?

A

Lateral aspects of the medulla

CN V, VIII

82
Q

Which parts of the brainstem are supplied by the anterior spinal artery?

A

Anterior midline medulla

Corticospinal tracts

83
Q

What are branchio motor structures?

A

Derived from pharyngeal arches
Muscles of facial expression, mastication, stylopharyngeus (IX), nucleus ambiguus (X - muscles of pharynx, palate, larynx),
CN V, VII, IX, X

84
Q

What does CN III motor nucleus damage cause?

A

Leads to eye positioned down & out at rest and a full ptosis

85
Q

What is the Edinger Westphal nucleus? And what symptoms would result from damage?

A

Parasympathetic nucleus involved in pupillary light reflex

Damage leads to ipsilateral loss of accommodation & pupil light reflex

86
Q

What is the red nucleus?

A

Linked to cerebellum & rubrospinal tract

Controls flexor muscle tone; If damaged possible tremor/ataxia of contralateral body

87
Q

What is the medial lemniscus?

A

Tract carrying contralateral dorsal column fibres

88
Q

Which cranial nerves emerge from the midbrain?

A

CN III, IV

89
Q

What does damage to CN IV nucleus lead to?

A

Contralateral loss of superior oblique function

Diplopia when reading & descending stairs; head tilted toward side of damaged nucleus

90
Q

At what level do the dorsal columns decussate?

A

Medial lemniscus in the medulla. Cross to anterior part of brainstem

91
Q

What are the 3 parts of the trigeminal nucleus?

A

Midbrain - proprioception - mesencephalic nucleus
Pons - touch - chief nucleus
Medulla - pain and temp - spinal nucleus

92
Q

Describe the path from the trigeminal nucleus to the sensory cortex

A

Trigeminothalamic tract decussates
Travels as trigeminal lemniscus
Travels via ventral posteriomedial nucleus of the thalamus to the sensory cortex

93
Q

Which brainstem nuclei are involved in sleep and wakefulness?

A

Reticular formation
Sleep - Midbrain raphe nuclei (seretonin)
Awake - Cholinergic neurons adjacent to cerulean excite the cortex
via the thalamus

94
Q

Which CNs leave the skull via foramen in the posterior cranial fossa?

A

CN IX - XII
Jugular foramen IJV & CN IX-XI
Hypoglossal canal CN XII

95
Q

What is the nucleus ambiguus?

A

Motor supply nucleus to branchiomotor muscles
CN IX (stylopharyngeus)
CN X (pharynx & larynx, upper 1/3 of oesophagus)
Cranial CN XI (larynx)

96
Q

What is the nucleus solitarius?

A

Special sensory information via visceral afferents

Taste, Visceral sensation (RS & GI), Baroreceptors & chemoreceptors (Carotid body & sinus), pneumotaxic centre etc

97
Q

What does the spinal part of CN XI supply?

A

Sternocleidomastoid and trapezius muscles

98
Q

What are the 4 medial structures which begin with M in the brainstem?

A 
Motor pathways (Corticospinal) - Contralateral weakness of UL/LL 
Medial lemniscus (dorsal column) - Contralateral loss of vibration & proprioception 
Medial longitudinal fasciculus - No ipsilateral eye adduction on lateral gaze 
Motor nuclei of CNIII, IV, VI & XII - Ocular palsies
99
Q

What are the 4 lateral structures which begin with S in the brainstem?

A

Spinocerebellar tract - Ipsilateral limb ataxia
Spinothalamic tract - Contralateral loss of limb pain and temp
Sensory nucleus of CNV - Ipsilateral facial pain and temp sensation loss
Sympathetic fibres - Ipsilateral Horner’s syndrome

100
Q

Which structures leave the skull via the foramen rotundum?

A

CN Vb

101
Q

Which structures leave the skull via the foramen spinosum?

A 
Middle meningeal artery
Meningeal nerve (CNVc)
102
Q

Which foramen in the skull do the CN Vc, lesser petrosal nerve and accessory meningeal artery?

A

Foramen ovale

103
Q

Which structures leave the skull via the superior orbital fissure?

A

CN III, IV, Va, VI

104
Q

Which foramen do the ophthalmic artery and CN II leave the skull by?

A

Optic canal

105
Q

Which structures leave the skull via the jugular foramen?

A

Internal jugular vein & CN IX-XI

106
Q

Which foramen does the hypoglossal nerve leave the skull by?

A

Hypoglossal canal

107
Q

Which structures leave the skull via the internal acoustic meatus?

A

CN VII, VIII

108
Q

What is the cavernous sinus?

A

Large dural venous sinus located to the left and right lateral sides of the pituitary fossa of the sphenoid bone containing internal jugular vein, CN III, IV, VI, Va, Vb

109
Q

Where does the cavernous sinus drain?

A

Pterygoid venous plexus

110
Q

Aneurysm of the internal carotid can compress nearby structures such as?

A

Lateral sides of optic chiasm - loss of nasal visual fields
CN VI - cross eyed
Sympathetic nerves to the face - Horners signs

111
Q

What are the ventricles of the brain?

A

Hollow regions, site of CSF production (500ml/day) via choroid plexus which forms the blood-CSF-barrier

112
Q

What does CSF do?

A

Support
Cushioning
Transport

113
Q

Where does CSF leave the ventricles?

A 
2 Lateral Apertures (Luschka) 
Median Aperture (Magendie)
114
Q

What connects the lateral ventricles to the 3rd ventricle?

A

Interventricular foramen (Monro)

115
Q

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

A

Cerebral aqueduct

116
Q

What does blockage of the ventricular system lead to?

A

Hydrocephalus
In child - head increase in size due to unfused sutures of skull
In adult - raised ICP

117
Q

Which cells produce CSF?

A

choroidal ependymal cells

118
Q

What forms the selectivity of the BBB?

A

Blood CSF barrier - Tight junctions and microvilli between choroidal ependymal cells
Blood ECF barrier - between capillary beds and neural tissue. Endothelial cells bound by tight junctions

119
Q

How much CSF is present at any one time?

A

150ml

120
Q

What are cisterns and where are they?

A 
Widened areas of the subarachnoid space
Quadrigeminal - above cerebellum
Prepontine 
Cisterna magna - below cerebellum
Lumbar
121
Q

What pathway does the CSF follow once it has left the ventricles?

A

Flows through subarachnoid space
Some CSF travels to lumbar cistern
Travels to arachnoid granulations for absorption into venous sinus blood
Granulations also sit around spinal nerves

122
Q

What are arachnoid granulations?

A

Project into the superior sagittal sinus

permit a one-way flow of CSF

123
Q

How can meningitis lead to increased ICP?

A

Block arachnoid granulations

124
Q

Describe the difference between a communicating and non communicating hydrocephalus

A

Communicating - blockage of arachnoid granulations

Non communicating - blockage of cerebral aqueduct, CSF can’t get out of ventricles

125
Q

What does damage to the superior temporal gyrus result in?

A

Injury leads to inability to recognise sounds e.g. Speech vs. a door opening

126
Q

What is the Posterior parietal cortex (superior lobule)? And what would damage here result in?

A

Integrates sensory inputs and controls perception of the contralateral environment/body
Damage can result in hemi-spatial neglect, Most often seen following right-sided damage, Patients ignore the contralateral half of their world, Walk into objects in affected visual field

127
Q

What is Achromatopsia?

A

Inability to recognise colours

128
Q

What is Prosopagnosia?

A

Inability to recognise faces

129
Q

Where are Facial, shape and colour recognition cortices located?

A

medial occpital lobe

Right side dominant

130
Q

What is Associative agnosia?

A

perceives object but does not recognise

Damage to visual association cortices

131
Q

What can damage to the Frontal eye field?

A

Eye deviation toward damaged side

132
Q

What is Dysphasia/Aphasia?

A

Defect of power of expression by speech or of comprehending spoken and written language

133
Q

What is a Broca’s dysphasia?

A

Motor speech - Content correct, but slow or missing words

134
Q

What is Wernickes dysphasia?

A

Receptive aphasia (auditory & reading) Content incorrect, but speech fluent

135
Q

What would a Angular gyrus lesion dysphasia present like?

A

Alexia / agraphia (inability to read or write)

136
Q

What would a lesion to 1° Auditory cortex present like?

A

Reduction of hearing sensitivity in both ears (mostly contralateral) & loss of stereo perception of sound origin

137
Q

Which side of the brain usually controls speech and language?

A

Left

138
Q

What would damage to the arcuate fasciculus result in?

A

Conductive aphasia
Fluent dysphasic speech
Understands spoken and written word

139
Q

What would damage to the corpus callosum result in?

A

Inability to name objects held in left hand

Inability to read via left half of visual fields

140
Q

What 4 ways can the arterial supply to the CNS be compromised?

A

Vessel occlusion – embolus or thrombus
Haemorrhage – burst aneurysm, degeneration of vessel wall
Aneurysm – often at sites of branching
Blocked venous drainage

141
Q

Where does the internal carotid branch off the common carotid?

A

C3-4

142
Q

Where do the vertebral arteries arise from?

A

Branches of subclavian artery
Pass up foramen transversarium & enter skull via foramen magnum
Supply the brainstem, cerebellum proximal spinal cord and posterior and inferior parts of the cerebral hemispheres

143
Q

Which territories are supplied by the carotid circulation?

A

ACA and MCA - anterior circulation

144
Q

What is the blood supply to the internal capsule?

A

medial & lateral striate arteries & anterior choroidal artery

145
Q

What is the limbic system involved with?

A

Sensations of emotion
Visceral responses to emotion
Memories

146
Q

Where is the limbic system ?

A

Made up from a rim of cortex: includes hippocampus & insula
Subcortical nuclei: amygdala, accumbens, septal, hypothalamic
Receives multiple inputs & provides multiple outputs

147
Q

What is Papez circuit?

A

hippocampal formation → fornix → mammillary bodies → mammillothalamic tract → anterior thalamic nucleus → cingulum → entorhinal cortex → hippocampal formation

148
Q

Where is the hippocampus?

A

Inferiomedial temporal lobe

Associated with inferior horn of lateral ventricle

149
Q

What does damage to the hippocampus produce?

A

Anterograde amnesia
No new memory formation
Patients are often be able to recall long term memories
Hippocampus also involved in memories involving spatial/ visuo-spatial tasks

150
Q

What is Korsakoff’s Psychosis?

A

Metabolic damage / alcohol abuse
Mamillary and anterior thalamic damage, thiamine (B1) deficiency
Anterograde amnesia & often retrograde amnesia
Patients insert fabricated ‘memories’ of long term events into current
conversation (confabulation)
Werickne-Korsakoff syndrome – Above + Ataxia, opthalmoplegia &
dementia

151
Q

What is the cingulate gyrus?

A

Cortical part of Papez circuit (limbic function)
Autonomic area: cardiorespiratoty & digestion, visceral response to emotions
Functions in emotional modulation of pain
Bladder control; Visual searching (for object)
Vocal area controlling appropriate sentence construction

152
Q

What emotional response is the Amygdala responsible for?

A 
Fear 
Anger 
Behavioural emotions 
Impulsivity 
Sexual behaviour & emotions
153
Q

What can stimulation of the Amygdala cause?

A 
Increase HR & BP 
Reduce saliva 
Increase GI motility 
Cause irritability 
Startle easily 
Increase muscle tension
Cause pupil dilation
154
Q

What area is involved in recognising emotional content of facial expression?

A

Amygdala

155
Q

What is Kluver-Bucy Syndrome?

A

Bilateral damage to the amygdala
Docile, lack fear or anger
Increased appetite & hypersexual
Excess exploratory behaviour with mouth and hands
Visual agnosia
Memory disorders: lack of facial/object recognition

156
Q

What are septal nuclei involved in?

A

Pleasure - sexual

157
Q

What is the nucleus accumbens involved in?

A

Dopamine-activated reward centre
Intense sense of well being
Amphetamine & cocaine activate

158
Q

What is the carotid sheath? Which structures lie inside it?

A

Membrane formed from the condensation of the cervical fascia, contains the internal carotid, internal jugular and vagus nerve

159
Q

Which arteries supply the spinal cord?

A

Anterior spinal artery and posterior spinal arteries

160
Q

The middle meningeal artery (which supplies the meninges) is a branch of which main artery? Where does it enter the skull?

A

The middle meningeal is a branch of External Carotid and enters the skull through the Foramen Spinosum

161
Q

One of the first symptoms of intracranial haemorrhage is a ‘worst-ever’ headache. What nerves carry the sensory input from the meninges?

A

The cranial nerves carrying sensory info from the meninges are CNV (trigeminal), CNX (vagus) and a bit of CNIX (glossopharyngeal) and also cervical nerves 2 & 3 (C1 rarely has a sensory component)

162
Q

What is the average blood flow in the brain (ml/100g/min)? How can you measure this?

A

60 ml/100g/min which can be measure by Doppler Ultrasound or Angiography

163
Q

Name the deep veins that drain the corpus striatum, choroid plexuses and thalamus. Which main sinus do these drain into?

A

Thalamostriate, choroidal and internal cerebral veins, which drain into the great cerebral vein and into the straight sinus

164
Q

Which main artery supplies the basal ganglia and internal capsule? What are the branches in this region known as?

A

The middle cerebral supplies the BG and IC and the branches are known as the Lenticulostriate arteries

165
Q

The plexus of veins known as the cavernous sinus surrounds sections of which artery and cranial nerves? This sinus drains via two routes, what are they?

A

cavernous sinus surrounds the internal carotid and CNIII (oculomotor), CNIV (trochlear), CNV (trigeminal) and CNVI (abducens). It drains via the superior petrosal sinus into the transverse sinus or the inferior petrosal sinus into the internal jugular vein

166
Q

Areas between the regions supplied by two adjacent cerebral arteries are most susceptible to ischaemia and infarction. What are these areas known as?

A

Watershed areas and infarcts are known as ‘Watershed infarcts’

167
Q

What are the consequences of a blockage of a cerebral artery by an embolus?

A

Stroke – ischemic death of regions supplied by the artery, effects depend on area damaged

168
Q

Define (a) ischaemic and (b) haemorrhagic stroke

A

a) Caused by blockage of a cerebral artery

b) Damage caused by leaking of blood within or around the brain

169
Q

What type of blood (arterial, venous, mixed) characterises Epidural (Extradural) haemorrhage?

A

Arterial

170
Q

What type of blood (arterial, venous, mixed) characterises a subdural haemorrhage?

A

Venous

171
Q

What type of blood (arterial, venous, mixed) characterises a subarachnoid haemorrhage?

A

Mixed - arterial and venous

172
Q

Which imaging procedure would be most useful in diagnosing an aneurysm in a cerebral artery?

A

CT scan

173
Q

What type of intracranial haemorrhage is most likely to result from a blow on the chin?

A

A blow to the chin generally Contrecoup injury when the brain rebounds from the blow, usually resulting in subdural haemorrhage

174
Q

Can a cerebral infarct raise intracranial pressure sufficient to produce coning?

A

Yes, if it reaches >15mm Hg, e.g. swelling and coning of temporal lobe

175
Q

What is diffusion weight imaging (DWI)? Following a stroke what is this technique useful for showing?

A

DWI is an MRI technique that maps the diffusion of water molecules in tissue. Useful for revealing ischemic damage and can reveal this far quicker that other MRI techniques following stroke

176
Q

Which spinal nerves innervate the hand?

A

C6-8

177
Q

Give 4 of the main signs used to distinguish upper and lower motor lesions

A

Pattern of weakness, pattern of wasting, plantar response, tendon reflexes, fasciculation (present/absent), tone of muscles, pain, sensory disturbance

178
Q

What is the window for thrombolysis?

A

You have 4.5 hours post stroke to administer thrombolytics

179
Q

What is the current recommended first line thrombolytics for ischaemic stroke?

A

Alteplase

180
Q

Why would you expect an older person to respond more slowly to a haemorrhaging stroke than younger patients?

A

Cerebral atrophy is a natural part of the ageing process and as a result elderly patients have more available space to accommodate increases in volume from the bleed and would show a slower increase in intra-cranial pressure

181
Q

What is a positive Romberg sign?

A

Instability when standing with eyes closed

Block 3 (8 decks)

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