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BMB Test 3 > B7.056 Prework: Brain Environs > Flashcards

B7.056 Prework: Brain Environs Flashcards

1
Q

major skull hole

A

foramen magnum- location of medullary, spinal cord junction

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2
Q

skull fossae and the part of the brain within them

A

anterior fossa- inferior frontal lobe
middle fossa- inferior temporal lobes
posterior fossa- brainstem and cerebellum

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3
Q

layers of meninges

A 
skull
dura
-outer leaflet adherent to periosteum of skull
-inner leaflet forms tentorium and falx
arachnoid
pia
-adherent to surface of brain
-follows penetrating arteries to form perivascular space
brain
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4
Q

meningeal spaces

A

epidural (between skull and dura)
subdural (between dura and arachnoid)
subarachnoid (between arachnoid and pain, contains CSF)

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5
Q

what are the tentorium and falx cerebri

A

sheets made of the inner leaflet of dura

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6
Q

falx

A

divides L and R hemispheres from top of brain to level of corpus callosum

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7
Q

tentorium

A

divides supra and infratentorial conpartments

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8
Q

components of supratentorial compartment

A

cerebral hemispheres

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9
Q

components of infratentorial compartment

A

cerebellum and brainstem

within posterior fossa

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10
Q

composition of normal CSF

A 
125 ml
clear, colorless
pressure: 70-180 mm H2O
0-5 WBCs
protein < 45 mg%
glucose 50-75 mg%
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11
Q

function of CSF

A

shock absorber
provides some nutrients
removes some waste

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12
Q

structure of the ventricles

A

4 total

  • 1 and 2 are lateral, C shaped and have an anterior, posterior, and inferior horn
  • 1 and 2 connect with 3 via interventricular foramen
  • 3 connects to 4 via cerebral aqueduct
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13
Q

extra-axial CSF spaces

A

contiguous with subarachnoid space over cerebral convexity

called cisterns

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14
Q

how is CSF produced

A

choroid plexus- specialized ependymal cells that produce an ultrafiltrate of plasma
located in ventricles
electrolyte comp similar to plasma
500 ml/ day produces

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15
Q

CSF circulation path

A

produces in ventricles
access to extra-axial space via median aperture (foramen of Magendie) and lateral apertures (foramen of Luschka) at medulla
percolate through subarachnoid space over cerebral convexities to arachnoid granulations

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16
Q

what causes CSF to flow

A

Pv&raquo_space; Psas

created gradient to drive flow

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17
Q

absorption of CSF

A

via arachnoid granulations within major sinuses (sagittal and transverse)
one way bulk transport of CSF to venous system

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18
Q

sagittal sinus

A

along top of falx

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19
Q

transverse sinuses

A

at intersection of tentorium and skull

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20
Q

major vessels of venous drainage

A

sagittal sinus
straight (rectus sinus)
transverse sinus
internal jugular

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21
Q

meningeal lymphatics

A

located parallel to the dural sinuses and meningeal arteries

drain immune cells, small molecules, and excess fluid from the CNS into the deep cervical lymph nodes

22
Q

blood brain barrier

A

tight junctions of brain capillaries endothelial cells limit transfer of molecules (esp ionized molecules)

23
Q

blood CSF barrier

A

tight junctions of choroid endothelial cells limit transfer of molecules

24
Q

significance of circumventricular organs

A

locations where BBB is interrupted

25
Q

major circumventricular organs

A

pineal > melatonin release
neurohypophysis/median eminence > pituitary hormone release
area postrema > chemotactic trigger zone

26
Q

4 types of herniation syndromes

A
  1. sub falcine
  2. central
  3. uncal
  4. tonsillar
27
Q

sub falcine herniation

A

brain pushed under falx

ACA and RAS live here and are vulnerable

28
Q

central herniation

A

compresses midbrain

sympathetic and parasympathetic fibers affected as visualized by pupils being midrange and nonreactive

29
Q

uncal herniation

A

lateral mass puts pressure on CN III exit from midbrain

unilateral, dilated, nonreactive pupil

30
Q

tonsillar herniation

A

life ending
compresses medulla
breathing and heart function impaired

31
Q

broad classes of causes of meningitis

A

inflammation of the meninges

  • infection
  • neoplastic
  • chemical
  • autoimmune
32
Q

symptoms and signs of meningitis

A 
headache
photophobia, sonophobia
nausea
nuchal rigidity
encephalopathy
cranial neuropathies
ischemic stokes
33
Q

acute bacterial meningitis CSF

A

100-5000 WBC (usually PMNs)
100-1000 protein
glucose < 40

34
Q

chronic, aseptic meningitis CSF

A

10-300 WBC (usually lymphocytes)
protein 50-100
normal or reduced glucose

35
Q

common causes of bacterial meningitis

A

listeria
h. flu
Neisseria
strep pneumo

36
Q

ttx for bacterial meningitis

A

ampicillin

ceftriaxone

37
Q

non communicating hydrocephalus

A

obstruction to flow intra-axial

4th ventricle not enlarged

38
Q

communicating hydrocephalus

A

obstruction to flow extra-axial

4th ventricle enlarged

39
Q

syndrome of hydrocephalus

A

gait problems
incontinence
cognitive issues
due to selective vulnerability of leg fibers, micturition center, and cingulum memory fibers near lateral ventricles

40
Q

diagnosis of hydrocephalus

A 
triad: gait problems, incontinence, cognitive problems
supportive imaging
lumbar puncture
-opening pressure
-meningitis?
41
Q

normal pressure hydrocephalus

A

very chronic, communicating hydrocephalus

42
Q

hydrocephalus ex vacuo

A

enlarged ventricles secondary to atrophy
no derangement in CSF flow
cortical sulci also enlarged

43
Q

pseudotumor cerebri

A

idiopathic intracranial hypertension

44
Q

etiologies of pseudotumor cerebri

A

poor absorption of CSF
rarely overproduction of CSF (choroid plexus papilloma)
venous sinus thrombosis

45
Q

factors associated with pseudotumor cerebri

A

obesity
tetracycline
vit A

46
Q

symptoms and signs of pseudotumor cerebri

A 
slowly developing headache
episodic blurred vision, vision loss
double vision
papilledema
normal head imaging
47
Q

treatment of pseudotumor cerebri

A

Diamox (decrease CSF production)
optic nerve fenestration
CSF shunt

48
Q

indication / contraindication of LP in increased ICP

A

contraindicated with focal mass lesions (increased P in once compartment compared to another)
not contraindicated in patients with diffuse processes
head imaging needed to exclude mass lesion

49
Q

causes of intracranial hypotension

A 
post traumatic
spontaneous
-encephalocele
-tarlov cyst
-idiopathic
50
Q

symptoms and signs of intracranial hypotension

A

orthostatic headaches

low opening pressure

51
Q

treatment of intracranial hypotension

A

repair leak

blood patch

BMB Test 3 (21 decks)

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