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Anatomy BLOCK 3 > Brain, Blood Supply, And Cranial Meninges > Flashcards

Brain, Blood Supply, And Cranial Meninges Flashcards

1
Q

What makes up the brain stem?

A
  • medulla oblongata
  • pons
  • midbrain
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2
Q

What are the parts of the brain?

A
  • brainstem
  • cerebellum
  • diencephalon
  • telencephalon (cerebral hemispheres)
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3
Q

What are the parts of the diencephalon

A

Thalamus

Hypothalamus

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4
Q

What are the parts of the medulla?

A
  • anterior median fissure
  • pyramids
  • olive
  • pre-olivary sulcus
  • retro-livery sulcus
  • medullopontine sulcus
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5
Q

Anterior median fissure of the medulla

A

Continuous inferiorly with anterior median fissure of spinal cord

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6
Q

Pyramids of medulla

A

Two longitudinal columns ( one on each side of the anterior median fissure)

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7
Q

Olive of the medulla

A

Oval elevation lateral to upper part of pyramid

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8
Q

Pre-olivary sulcus of the medulla

A

Located between the pyramid and the olive

Attachments of rootlets of hypoglossal nerve (CN XII)

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9
Q

Retro-olivary sulcus of the medulla

A
  • located posterior to olive
  • attachment of rootlets of glossopharyngeal (CN IX) and vagus (CN X) nerves (in line with attachment of rootlets of accessory nerve/CN XI)
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10
Q

Medullopontine sulcus of the medulla

A

Nerves that attaché (from medial to lateral)

  • abducens (CN VI)
  • facial nerve (CNVII)
  • vestibulocochlear (CN VIII)
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11
Q

Pons

A

-trigeminal nerve (CN V) attaches to anterior surface of pons

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12
Q

Midbrain

A 
cerebral crura (cerebral peduncles)
-two columns of descending fibers (one on each side)
Occulomotor nerve (CN III) attaches to medial border of cerebral crus
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13
Q

4th ventricle

A
  • posterior surface of brainstem

- cavity between cerebullum (posteriorly) and pons and upper medulla (anteriorly)

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14
Q

When can the posterior surface of the brainstem be viewed completely?

A

When cerebellum is removed by cutting 3 pairs of cerebellar peduncles (superior, middle, and inferior) that connect cerebellum to brainstem

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15
Q

What is the posterior surface of the lower medulla similar to?

A

Posterior surface of cervical and upper thoracic spinal cord

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16
Q

Posterior surface of upper medulla and posterior surface of pons form what?

A

The floor of 4th ventricle, called the rhomboid fossa

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17
Q

What are the elevations of the posterior surface of midbrain?

A

Two superior colliculi
-part of visual system
Two inferior colliculi
-part of the auditory system

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18
Q

What is the only cranial nerve attaches to posterior surface of brainstem?

A 
Trochlear nerve (CN IV)
-emerges immediately below inferior colliculus
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19
Q

What are the right and left cerebral hemispheres separated by?

A

Longitudinal fissure

  • separation is incomplete
  • at bottom of longitudinal fissure, there is a large bundle of fibers (corpus callosum) that connects right and left hemispheres
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20
Q

How many lobes does each hemisphere have?

A

5

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21
Q

What are the lobes that each hemisphere contains?

A
  • frontal
  • parietal
  • temporal
  • occipital
  • insular
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22
Q

Which lobe is hidden in the lateral sulcus?

A

Insular

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23
Q

What separates the frontal and parietal lobes?

A

Central sulcus

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24
Q

What separates the temporal lobe from frontal and parietal lobe?

A

Lateral sulcus

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25
Q

What two arteries provided the arteries last supply of the brain?

A
  • vertebral arteries

- internal carotid arteries

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26
Q

What part of the subclavian does the vertebral artery come off of?

A

1st branch

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27
Q

Where does the vertebral artery enter the cranial cavity?

A

Foramen magnum

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28
Q

Where do the right and left vertebral arteries join each other?

A

At medullopontine sulcus to form basilar artery

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29
Q

How does the basilar artery run?

A

Along midline of anterior surface of pons and ends at upper end of pons by dividing into right and left posterior cerebral arteries (terminal branch)

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30
Q

What do the vertebral and basilar branches supply?

A

-spinal cord
-brainstem
-cerebellum
-posterior parts of cerebral hemispheres
(Essentially entire brainstem and occipital lobe)

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31
Q

Where does the internal carotid artery start?

A

Begins at bifurcation of common carotid artery

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32
Q

What are the parts of the internal carotid artery

A
  • cervical
  • petrous
  • cavernous
  • cerebral
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33
Q

Cervical part of the internal carotid artery

A

From origin to base of skull

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34
Q

Petrous part of internal carotid artery

A

Within carotid canal in petrous part of temporal bone

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35
Q

Cavernous part of internal carotid artery

A

Within cavernous sinus (dural venous sinus located in middle cranial fossa, one on each side of sella turcica)

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36
Q

Cerebral part of internal carotid artery

A

After it exits cavernous sinus to its termination, where it divides into anterior and middle cerebral arteries

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37
Q

Internal carotid artery branches

A
  • ophthalmic
  • posterior communicating artery
  • anterior cerebral artery
  • middle cerebral artery
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38
Q

How does the ophthalmic artery enter the optic canal;?

A

Together with optic nerve

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39
Q

What connects the internal carotid and posterior cerebral arteries?

A

Posterior communicating artery

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40
Q

What are the right and left cerebral arteries connected to each other by?

A

Communicating artery

41
Q

What surface of brain is circle of willis on?

A

Ventral

42
Q

What are the components of the circle of willis?

A
  • anterior communicating artery (tiny)
  • anterior cerebral artery
  • internal carotid artery
  • positive or communicating artery
  • posterior cerebral artery
43
Q

What is the purpose of the circle of willis?

A

Serves as a potential vascular shunt, assisting in development of collateral circulation if one of the proximal vessels is occluded

44
Q

What are the laters of the dura mater of the brain?

A
  • periosteal/endosteal (outer later)

- meningeal (inner layer)

45
Q

Periosteal/endosteal layer of the dura mater

A
  • outer layer

- covers inner surface of skull bones

46
Q

Meningeal layer of the dura mater

A
  • inner layer
  • dura mater proper
  • faces brain
47
Q

Relationship of the periosteal/endosteal and the meningeal layers of the dura mater

A

Two layers are closely united, except where they separate to form dural venous sinuses

48
Q

Falx cerebri

A
  • Dural septa formed by the meningeal layer
  • sickle-shaped fold that lines in midline between right and left cerebral hemispheres
  • from front to back
49
Q

Tentorium cerebelli

A
  • crerbellum lives under this
  • crescent shaped for that roofs over posterior cranial fossa (separates cerebellum from occipital lobes of cerebral hemispheres)
  • tentorial notch opening filled mostly by midbrain
50
Q

Falx cerebelli

A

Small sickle shaped fold in posterior cranial fossa that projects between right and left cerebellar hemispheres

51
Q

Diaphragma sellae

A

Small circular fold that forms roof of sella turcica (has small opening for pituitary stalk)

52
Q

Where are the dural venous sinuses located?

A

Between inner and outer laters of dura mater

53
Q

What do dural venous sinuses receive blood from?

A

Brain as well as CSF from subarachnoid space

54
Q

Where does the blood collected in the dural venous sinuses drain into?

A

Internal jugular veins

55
Q

What are the dural venous sinuses?

A
  • superior sagittal sinus
  • inferior sagittal sinus
  • straight sinus
  • transverse sinus
  • sigmoid sinus
  • occipital sinus
  • cavernous sinus
  • superior petrosal sinus
  • inferior petrosal sinus
  • sphenoparietal sinus
56
Q

Superior sagittal sinus

A
  • runs along upper border of falx cerebri
  • begins anteriorly at foramen cecum
  • terminates posteriorly in confluence of sinuses (over internal occipital protuberance)
57
Q

Inferior sagittal sinus

A

-runs along lower, free border of falx cerebri, joins great cerebral vein (of Galen) to form straight sinus

58
Q

Straight sinus

A
  • runs in midline along junction of falx cerebri and tentorium cerebelli
  • terminates posteriorly in confluence of sinuses
59
Q

Transverse sinus

A
  • begins in confluence of sinuses and runs along posterior border of tentorium cerebelli
  • when it reaches petrous part of temporal bone, it turns down to become continuous with sigmoid sinus
60
Q

Sigmoid sinus

A
  • direct continuation of transverse sinus

- terminates in jugular foramen where is becomes continuous with internal jugular vein

61
Q

Occipital sinus

A
  • small sinus that runs along posterior border of falx cerebelli
  • ends superiorly in confluence of sinuses and inferiorly communicated with internal vertebral venous plexus (within vertebral canal)
62
Q

Where is the cavernous sinus located?

A

In middle cranial fossa, one on each side of sella turcica

63
Q

What does the cavernous sinus drain?

A

Contents of orbit, parts of cerebral hemisphere, pituitary gland, and sphenoparietal sinus

64
Q

What two structures are located within the cavernous sinus?

A

Internal carotid artery and abducens nerve

65
Q

What runs within lateral walls of the cavernous sinus?

A

CN III, IV, and V1 and V2 divisions of trigeminal nerve

66
Q

What is the canvernous sinus drained by?

A

Posteriorly by superior and inferior petrosal sinuses

67
Q

Superior petrosal sinus

A
  • runs along superior border of petrous part of temporal bone
  • connects cavernous sinus with terminal part of transverse sinus
68
Q

Inferior petrosal sinus

A
  • runs along inferior border of petrous part of temporal bone (between petrous part and occipital bone)
  • connects cavernous sinus with internal jugular vein
69
Q

Sphenoparital sinus

A

Small sinus that runs along posterior border of lesser wing of sphenoid, then drains into cavernous sinus

70
Q

What is the age of peak incidence of a primary parenchymal hemorrhage?

A

60

71
Q

What is a primary brain parenchymal hemorrhage?

A

Rupture of small intraparenchymal vessel

72
Q

What is the most common underlying cause of primary brain parenchymal hemorrhage?

A

Hypertension (15% of deaths with chronic HTN)

73
Q

What are the most common sites in order of a primary brain parenchymal hemorrhage?

A

Basal ganglia
Thalamus
Pons
Cerebellum

74
Q

Location and size of primary brain parenchymal hemorrhage

A

Determine clinical manifestations

75
Q

What is the most frequent cause of clinically significant subarachnoid hemorrhage?

A

Rupture of a saccular aneurysm

76
Q

Where do 90% of saccular aneurysms occur?

A

In the anterior circulation

77
Q

How often do multiple aneurysms occur in saccular aneurysms?

A

20-30%

78
Q

Risk of bleeding increases with that in saccular aneurysms?

A

Size

79
Q

What percentage of people die with firstly rupture during saccular aneurysm?

A

25-50%

80
Q

What is likely to cause “the worst headache of your life?”

A

Saccular aneurysm

81
Q

What is the most common site of saccular aneurysm?

A

Branch of anterior communicating and anterior cerebral

82
Q

What is the breakdown of how saccular aneurysms affect people?

A

1/3 die
1/3 survive and have second one
1/3 will be totally fine

83
Q

Morphology of saccular aneurysms

A
  • thin walled out pouching of an artery
  • muscular wall and internal elastic lamina are absent from sac
  • sac is thickened hylainized intima
84
Q

What is absent from the sac in an saccular aneurysm?

A

Internal elastic Lamina and muscular wall

85
Q

What is the sac thickened by in saccular aneurysm?

A

Hyalinized intima

86
Q

What is an epidural hematoma?

A
  • torn vessel in the dura

- middle meningeal artery

87
Q

What is usually associated with an epidural hematoma>?

A

Skull fracture

88
Q

What happens with a epidural hematoma?

A
  • blood under arterial pressure separates dura from inner surface of the skull
  • smooth inner contour that compresses the brain
  • patients can be lucid for several hours between trauma and development of neurological signs
  • neurosurgical emergency
89
Q

Sub dural hematoma

A

Tearing of bridging veins caused by rapid movement of the brain

90
Q

Where is the bleeding occurring in a sub dural hematoma?

A

Sub dural space

91
Q

Where is a sub dural hematoma most common?

A

Over lateral aspect of cerebral hemispheres

-10% bilateral

92
Q

Increased risk of subdural hematoma

A
  • brain atrophy-stretched veins

- infants-thin walled veins

93
Q

When does subdural hematoma become manifest?

A

Within 48 hours of injury

94
Q

What are the signs of a subdural hematoma

A
  • attributable to pressure on the brain
  • headache, confusion, sometimes localizing
  • progressive neurological deterioration, rarely with acute decompensation
95
Q

Bleeding of a subdural hematoma

A

Usually self-limited

96
Q

If the subdural hematoma is not evacuated

A

Hematoma will organize over time

  • fibroblasts grow from dura
  • granulation tissue matures and forms ‘subdural membranes’
97
Q

Chronic subdural hematoma

A

Subdural hematoma often rebleed

98
Q

How are symptomatic subdural hematomas treated?

A

By removing the organizing blood and tissue

Anatomy BLOCK 3 (13 decks)

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