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Block 5; Week 1 > Cranial Cavity--Sievert > Flashcards

Cranial Cavity--Sievert Flashcards

1
Q

What are the 2 main divisions of the skull?

A
  1. Neurocranium–the area that surrounds the brain

2. Viscerocranium–bones of the face

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2
Q

How is the neurocranium mainly formed? Which bones are components?

A

mainly large flat bones

formed mainly intramembranously

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3
Q

What are the 3 embryological derivatives of the skull?

A

Neural crest–Ectoderm
Paraxial Mesoderm–Somites
Lateral Plate Mesoderm

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4
Q

Where does the division b/w the neural crest & the somites occur?

A

this happens at the precordal plate at the rostral end of the notochord.

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5
Q

T/F Sometimes there is overlap that occurs in which some paraxial mesoderm is anterior to the prechordal plate.

A

False. If you are anterior to the prechordal plate–>neural crest cells.

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6
Q

What is the embryological derivative of the sphenoid bone?

A

most of it is neural crest

a small posterior portion of it is paraxial mesoderm

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7
Q

There is a chunk of neural crest tissue @ the rostral end of the notocord. What does it give rise to? What is the clinical significance of this?

A

Facial Structures of the skull
Heart Structures
**if you see congenital facial deformities in a child, look for heart problems–>probably present b/c they originate from the same tissue.

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8
Q

Which embryonic derivative does the laryngeal cartilage come from?

A

lateral plate mesoderm.

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9
Q

What are the 2 types of bone formation?

A

Endochondral Ossification

Intramembranous Ossification

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10
Q

What are the 2 components of the neurocranium?

A

The membranous & cartilaginous parts.

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11
Q

What makes up the membranous part? Why is it called this?

A

The frontal bone, parietal bones, part of the temporal bones, part of the occipital bone.
Called this b/c they are formed via intramembranous ossification.
Note: these are mainly flat bones.

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12
Q

The occipital bone is formed via intramembranous ossification & some __________.

A

endochondral ossification.

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13
Q

The Cartilaginous portion of the neurocranium is called what? It is formed via which type of ossification? This mainly applies to bones in the _______.

A

Called chondrocranium
Formed via endochondral ossification.
Mainly in bones in the base of the skull.

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14
Q

Which bones are a part of the chondrocranium–cartilaginous portion of the neurocranium?

A

Sphenoid Bone
Ethmoid Bone
Part of Temporal Bone
Part of Occipital Bone

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15
Q

T/F All of the components of the neurocranium are from the embryological derivative paraxial mesoderm.

A

FALSE. They come from different embryological derivatives…these are separate concepts. Think about fcn of housing brain when you think about the neurocranium.
So the sphenoid bone is derived from both neural crest & paraxial mesoderm & is a part of the cartilaginous portion of the neurocranium.

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16
Q

What are the exceptions to the general statement that the large flat bones of the neurocranium are membranous?

A

The temporal bone & occipital bone are partially formed via endochondral ossification.

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17
Q

T/F Due to their different ossification processes, the temporal bone & occipital bones are a part of both the neurocranium & viscerocranium.

A

False. They are entirely a part of the neurocranium. They are just partially a part of the membranus & cartilaginous portions of the neurocranium. Once again–>concepts of ossification, neuro v. viscerocranium, & embryological derivatives. A LOT of overlap.

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18
Q

T/F Bones of the floor of the cranial cavity form via endochondral ossification.

A

True. This includes the sphenoid, ethmoid, & part of the temporal bone.

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19
Q

Viscerocranium develops primarily from _____ and comes from ______.
-Some parts of the viscerocranium develop from ___________.

A

membrane
comes from neural crest

**cartilaginous models.

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20
Q

Which parts of the viscerocranium develop from a cartilage model?

A

middle ear ossicles, laryngeal cartilages and hyoid bone.

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21
Q

When you see craniofacial defects what should you think?

A

think neural crest problem

look for other defects, including @ the heart.

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22
Q

Why do newborns have a small face?

A

lack of teeth–>small jaw
no paranasal sinuses
facial bones underdeveloped

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23
Q

Which fontanels do you see in a newborn?

A 
6
Anterior
Posterior
Sphenoid-Lateral (2)
Mastoid-Lateral (2)
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24
Q

What happens @ fontanels in a newborn?

A

these are areas where flat bones of the skull meet & eventually form sutures
these allow for overlap during the birthing process

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25
Q

Premature suture closure causes what condition?

A

craniosynostosis

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26
Q

What happens if you have incomplete closure of the anterior neuropore?

A

the skull bones will fail to grow together

**can result in cranioschisis

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27
Q

What is a cranioschisis a variant of?

A

spina bifida

main difference is that it occurs at the rostral end of the neural tube

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28
Q

What exactly occurs in cranioschisis?

A

neural tube fails to close
brain tissue exposed to amniotic fluid & degenerates
can result in anencephaly
fetus usu not viable

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29
Q

What are 2 variants of cranioschisis? What are the differences b/w them?

A

Meningocele: meninges are bulging out
Meningoencephalocele: meninges & brain vesicles are bulging out

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30
Q

What are the 5 brain vesicles?

A 
Telencephalon
Diencephalon
Midbrain
Pons
Medulla
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31
Q

Describe the epidural space in the cranial cavity.

A

Trick Q! There is NO true epidural space in the cranial cavity. This only starts @ the spinal cord after the foramen magnum. There is a “potential epidural space” in the cranial cavity. The dura is fused tightly to the bones of the cranium & there are even some CT spicules connecting everything.

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32
Q

T/F The dura mater forms the periosteum of the interior cranial cavity.

A

True

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33
Q

Where are the meningeal arteries that supply the cranial cavity found?

A

They are found b/w the skull & dura mater. This is in the potential epidural space. You can even see the impression of these arteries in the skull.

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34
Q

Describe the layers of the dura mater.

A

There are 2 layers.
Periosteal layer–located closest to the bone
Meningeal layer–located closest to the arachnoid mater
**they can’t be separated.

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35
Q

What is it called when the 2 layers of the dura mater are naturally separate?

A

called dural sinus

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36
Q

Once again, what is it called when there is a rupture of a meningeal artery?

A

epidural hematoma

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37
Q

What are the different branches of meningeal arteries found in the cranial cavity? Which is most susceptible to injury?

A

Middle meningeal–most susceptible to injury b/c of the thinness of the surrounding bones
Anterior meningeal
Posterior meningeal

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38
Q

The middle meningeal artery is a branch of what artery? Which hole in the skull does it enter thru?

A

branch of maxillary artery

goes thru foramen spinosum.

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39
Q

What is an epidural hematoma?

A

This is a condition in which a meningeal artery (usu middle) ruptures & creates a high pressure bleed in the epidural space. It creates a space where there wasn’t one by separating the dura mater from the bone. Causes compression of the brain & increase in intracranial pressure.

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40
Q

Can an epidural hematoma be deadly?

A

Absolutely, 15-20% of ppl who have it die.

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41
Q

Why is an epidural hematoma deadly?

A

b/c it is known as a space occupying lesion. It pushes on the structures of the brain…the first of which to go are the cardiovascular & resp centers. Deadly.

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42
Q

How do you treat an epidural hematoma?

A

you drill holes into the skull to decrease the intracranial pressure. you take measures to stop the bleed.

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43
Q

What is the hallmark of an epidural hematoma?

A

a lucid interval
pts will go in & out of consciousness
sometimes pt will regain consciousness & then die suddenly–>called Talk & Die Syndrome

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44
Q

Where is the arachnoid mater located in the cranial cavity? What is found underneath it?

A

It is located right underneath the dura mater. It is usu sitting tightly up against it. Underneath this is the subarachnoid space.

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45
Q

What do you find in the subarachnoid space?

A

you find CSF

you also find cerebral arteries & veins

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46
Q

T/F You find meningeal arteries on top of the arachnoid mater once you peel back the dura mater.

A

FALSE You find some cerebral veins. No meningeal arteries b/c those are on top of the dura mater.

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47
Q

Why do you sometimes see cerebral veins on top of the arachnoid mater?

A

b/c the cerebral veins in the subarachnoid space pierce thru the arachnoid mater to empty out to a dural sinus at some point.

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48
Q

What is one of the main sinuses for cerebral veins to empty into?

A

parasagittal sinus

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49
Q

What would be the relationship b/w the arachnoid mater & the brain if the CSF was gone from the subarachnoid space?

A

It would collapse against the brain

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50
Q

What do you see running thru the sulci in a gross brain?

A

you see the cerebral vessels in the subarachnoid space.

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51
Q

If a cerebral vein is ruptured in a dural sinus, what can you get?

A

a subdural hematoma

**this is low pressure, but can be dangerous over time as pressure builds up

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52
Q

What are arachnoid villi or granulations? What is their fcn?

A

These are funky looking portions of arachnoid mater that also pierce their way thru the dura mater to get to the dural sinus. They act as a one-way valve that releases CSF fluid into the dural sinus

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53
Q

Where is CSF produced? How frequently is it produced? What is one of the most important fcns of CSF?

A

It is produced continually in the choroid plexus of the ventricles
**one of the most important fcns is buoyancy

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54
Q

Where is the pia mater found?

A

directly overlying the brain. Underneath the subarachnoid space. It follows all the sulci & gyri

55
Q

What is found in the subdural sinuses? Where does it drain to?

A

Here you find CSF from the arachnoid villi & you find blood from the cerebral veins. It eventually drains into the internal jugular vein.

56
Q

What are the veins called that go thru the skull & into the scalp? What is their clinical significance?

A

These are called emissary veins. They can spread infection from the scalp to the subdural sinus.

57
Q

If you get an infection in one section of the scalp…which structure makes it super easy for that to spread across the scalp? And with the help of emissary veins potentially into a subdural sinus?

A

the loose areolar tissue that is found beneath the galea aponeurotica & above the periosteum.

58
Q

The meningeal dura help form the dural sinus…but else do they help form?

A

dural reflections

59
Q

What are the 2 examples of places where the 2 layers of the dura mater split?

A 
dural sinuses
dural reflections (think meningeal dura on each side)
60
Q

What is the name of the dural reflection that separates the 2 hemispheres of the brain?

A

the falx cerebri

61
Q

Which one of these is more dangerous?
ASDH: Acute Subdural hematoma
CSDH: chronic subdural hematoma

A

The acute subdural hematoma is more dangerous.

50% survival rate

62
Q

What do you need to know about acute subdural hematomas?

A

blood gathers quickly in the subdural space
usu occurs after traumatic brain injury
get cerebral edema usu too
need surgery to recover

63
Q

What do you need to know about chronic subdural hematomas?

A

blood gathers slowly in the subdural space
usu doesn’t occur after a noticeable brain injury
outcome is relatively good
requires careful observation & slow drainage

64
Q

What is the clinical significance of dural reflections?

A

when you have a space occupying lesion that pushes around brain structures…they will be forced under or around these dural reflections & that can cause damage.

65
Q

What are the 3 dural reflections that we talk about?

A 
Falx Cerebri (separates the 2 hemispheres of the cortex)
Tentorium Cerebelli (separates the cerebellum from the cortex)
Falx Cerebelli (separates somewhat the 2 halves of the cerebellum)
66
Q

T/F Tentorial notch of the tentorium cerebelli allows the brainstem space to come thru.

A

True.

67
Q

T/F The dural reflections are closely associated with arterial blood pockets.

A

False. With venous sinuses.

68
Q

Where is the straight sinus located?

A

it is located @ the intersection b/w the falx cerebri & the tentorium cerebelli
2 major veins drain into this
it goes toward the confluens

69
Q

Why can prostate cancer be so dangerous?

A

b/c if it gets into the internal venous plexuses it can drain upwards & eventually get into the cranial cavity @ the inferior occipital sinus

70
Q

Most of the sinuses drain to the confluens. Everything eventually drains from the internal jugular vein. What are the dural sinuses that we have talked about?

A 
Superior Sagittal Sinus
Inferior Sagittal Sinus
Straight Sinus
Confluens
Transverse Sinus
Sigmoid Sinus
Cavernous Sinus
71
Q

Where is the cavernous sinus located?

A

on either side of the sphenoid bone

72
Q

What structure does V1 go thru? V2? V3? Which of these go thru the cavernous sinus?

A

V1: superior orbital fissure
V2: foramen rotundum
V3: foramen ovale
**only V1 & V2 go thru the cavernous sinus

73
Q

Which carotid artery goes into the cranial cavity? Where does it end?

A

only the internal carotid artery

ends in the circle of Willis

74
Q

What all do you see in the cavernous sinus?

A 
parotid gland
internal carotid artery
CN V1
CN V2
CN 3, 4, 6
75
Q

What structure does the parotid gland sit in?

A

it sits in the sella turcica

76
Q

What are some important venous plexuses/veins that drain into the cavernous sinus?

A

opthalmic plexus
pterygoid plexus
facial vein

77
Q

What is the triangle of death?

A

it is an area of your face where you shouldn’t pop pimples for risk of causing a facial infection that could make its way into the facial vein & spread into the cranial cavity via the cavernous sinus. could be deadly theoretically.
this is the area above your mouth & around your nose.

78
Q

In the triangle of death which direction does blood flow?

A

it flows in a variety of directions based on the amount of blood–>no one way valves.

79
Q

What separates the lateral ventricles?

A

the septum pellucidum

80
Q

How do the lateral ventricles communicate w/ the 3rd ventricle?

A

the inter ventricular foramen of Monroe

81
Q

How is CSF made? Where is it released?

A

CSF made by the choroid plexus that lines all of the ventricles
released into the subarachnoid space

82
Q

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

A

the cerebral aqueduct

83
Q

What important space is the 4th ventricle connected to?

A

the subarachnoid space where CSF is released

84
Q

If you blocked the flow of CSF at any point–>like the cerebral aqueduct or something…what would occur?

A

this causes increased pressure inside the brain

85
Q

If you block reabsorption of CSF into the venous system…what occurs?

A

increased pressure inside & outside of the brain

86
Q

What are 2 types of hydrocephalus?

A

communicating & non-communicating

87
Q

Describe the special shape of the lateral ventricles.

A

They are C shaped & extend into all the different lobes of the brain.

88
Q

Where are the 3 places that CSF can drain into the subarachnoid space?

A

3 foramen in the 4th ventricle
1 midline foramen–>Foramen of Magendie
2 lateral foramen–>Foramen of Luschka

89
Q

Once the CSF is in the subarachnoid space–>how does it exit?

A

it can leave via reabsorption into the dural sinuses.

this happens via arachnoid granulations

90
Q

What is it called when you get a buildup of CSF?

A

hydrocephalus

  • *too much production or inadequate reabsorption
  • *dilation of ventricles–>increased intracranial pressure
91
Q

Describe the journey of CSF.

A 
Choroid Plexus
Lateral Ventricles
3rd Ventricle
Cerebral Aqueduct
4th Ventricle
Cisterna Magna
Subarachnoid Space
92
Q

______ ml/day is produced of CSF and most of it is resorbed by the arachnoid granulations. Capacity ~____.

A

400-500 ml/day

Capacity: 150 mL

93
Q

What are the functions of CSF?

A

buoyancy
nutrition
waste removal

94
Q

What are subarachnoid cisterns?

A

these are places of enlarged subarachnoid space

arachnoid follows a smooth course while CNS tissue takes an abrupt turn

95
Q

What are some important subarachnoid cisterns? Which is the most important?

A

Superior Cistern
Interpeduncular Cistern
Pontine Cistern
Cisterna Magna**most important

96
Q

How can you see the cisterna magna?

A

you can usu see it when you take off the arch of the atlas

this is located near the 4th ventricle

97
Q

What do you find near the interpeduncular cistern?

A

the 2 big cerebral peduncles

you also see some cranial nerves popping off, like CN3

98
Q

What is the superior cistern located next to?

A

the place where the tentorium cerebelli meets the colliculi of the brainstem (midbrain)

99
Q

How might hydrocephalus appear in an infant?

A

they might have a super huge head b/c of the increased pressure & b/c their sutures aren’t fully closed
can result in atrophy of the brain

100
Q

What are the 2 main sources of blood supply to the brain?

A

the internal carotid arteries

vertebral arteries

101
Q

Describe how the internal carotid arteries & vertebral arteries contribute to the blood supply of the brain.

A

Internal carotid artery branches off of the common carotid artery. It gives off a branch to the eye & then continues & ends @ the circle of Willis
The vertebral arteries travel thru the transverse foramina of the cervical vertebrae & go thru the foramen magnum. They combine to form the basilar artery & sit on a special occipital bone thing & continue up the bases of the cerebral hemispheres & then give off terminal branches in the circle of Willis

102
Q

What is the name of the special part of the occipital bone that the basilar artery rests on?

A

clivus

like a ski slope

103
Q

Where is the last place of collateral flow in the brain?

A

the circle of Willis

after that all terminal branches

104
Q

Describe the Circle of Willis.

A

2 vertebral arteries come from the back & form one basilar artery.
This branches into 2 posterior cerebral branches that head posteriorly.
It also branches into 2 posterior communicating branches that join the middle cerebral arteries or internal carotid arteries.
The internal carotid arteries come up sorta centrally & branch into 2 middle cerebral arteries that go off to the side & 2 anterior cerebral branches that go forward. There is then one anterior communicating branch that connects the 2 anterior cerebral branches.

105
Q

Where do the posterior cerebral arteries go?

A

they head back to supply the occipital lobe

106
Q

Where do the middle cerebral arteries go?

A

they head underneath the temporal lobe to supply the lateral surface of the hemisphere

107
Q

Where do the anterior cerebral arteries go?

A

they head up b/w the inter hemispheric fissure

108
Q

Where does the anterior cerebral artery branch from?

A

can branch from the internal carotid artery or the middle cerebral artery

109
Q

T/F If there is a blockage of an artery in the brain, the stroke symptoms will coordinate to the area of the brain that the artery supplied.

A

True

110
Q

What does CVA mean? What causes it?

A

cerebral vascular accident

caused by an obstruction or rupture of a cerebral vessel

111
Q

What are the 2 main categories of CVAs? What are the 3 types?

A
  • *Ischemic
    1. Thrombotic Stroke
    2. Embolic Stroke
  • *Cerebral Hemorrhage
    3. Hemorrhagic Stroke
112
Q

What is a thrombotic stroke?

A

a blood clot (thrombus) blocks blood flow to the brain

causes ischemia

113
Q

What is an embolic stroke?

A

a fatty plaque of cholesterol or a blood clot breaks away from somewhere else & flows into the brain where it blocks an artery
causes ischemia

114
Q

What is a hemorrhagic stroke? Why is this particularly bad?

A

an aneurysm in the brain (break in a blood vessel)
you get an area of bleeding & the blood that is released is cytotoxic to cells…once these cells are killed they release their cell contents which are cytotoxic to other cells. Cyclical damage.

115
Q

What is the significance of the tenurial notch in the tentorium cerebelli?

A

this is where the brainstem meets up with the cerebral hemispheres

116
Q

What are the 3 cranial fossa & what sits in each of them?

A

Anterior Cranial Fossa: frontal lobe sits here
Middle Cranial Fossa: Temporal lobes sit here
Posterior Cranial Fossa: occipital lobe & cerebellum sits here

117
Q

Where is the cribriform plate found? What goes thru this?

A

this is found in the ethmoid bone

little tiny olfactory nerves from the olfactory bulb will pierce this & make their way into the nasal cavity

118
Q

Where is the optic canal found? What goes thru here?

A

this is found in the sphenoid bone

optic nerve

119
Q

Where is the superior orbital fissure found? What goes thru here?

A

this is a tiny crack in the sphenoid bone

V1, CN 3, 4, 6 goes thru here–>on their way to the extra ocular eye muscles

120
Q

Where are the foramen rotundum & foramen ovale found? What do they allow the passage of?

A

they are both found in the sphenoid bone

they allow V2 & V3 respectively to go thru.

121
Q

Where is the foramen lacerum found? What goes thru here?

A

This is near the carotid canal. This is sorta in b/w the sphenoid, temporal, & occipital bones.
A bunch of cartilage fills in this space. An emissary vein is found here too.

122
Q

Where is the carotid canal found? What runs thru here?

A

this runs thru the temporal bone. You can sorta see its opening near the foramen lacerum.
internal carotid artery is found here

123
Q

Where is the internal acoustic meatus found? What runs thru here?

A

this is found in the temporal bone
CN 7 & 8 run thru this. 7 goes into the middle ear cavity & leaves via the stylomastoid foramen
8 goes into the ear & never leaves the skull.

124
Q

What goes thru the jugular foramen? Where is this found?

A

it is located in b/w the temporal & occipital bones.

this is where CN 9, 10, 11 are found

125
Q

What is the pathway of CN 9 & 10?

A

they come from the medulla & pass thru the jugular foramen

126
Q

What is the pathway of CN11?

A

it has its origin from some cell bodies in the upper cervical spinal cord. They pass up thru the foramen magnum & back down again thru the jugular foramen.

127
Q

Where is the hypoglossal canal located? What pass thru there?

A

this opening is in the occipital bone.

CN12 leaves the skull here.

128
Q

The cranial nerves with the shortest/longest course are most susceptible to being damaged.

A

those with the longest course

129
Q

WHere might an acoustic neuroma form? Which CNs could this potentially affect?

A

could form on CN8. This could end up affecting 5, 6, 7, 9, 10

130
Q

T/F The cranial nerves exit the brainstem at a different spot than they exit the cranial cavity.

A

Sometimes true. Yes.

131
Q

Which cranial nerve has the longest course & is therefore most susceptible to damage? What is its path?

A

Cranial Nerve 6.
passes thru a dural sleeve as it leaves the brainstem thru the pontomedullary jcn
passes thru the cavernous sinus
goes out via the superior orbital fissure

132
Q

Aside from CN6, which other cranial nerves are particularly susceptible to damage?

A

CN3-5 b/c they have a long course in which they exit the brainstem in the posterior fossa & travel intradurally into the middle fossa where they leave the skull

133
Q

T/F CN 7-12 exit the brainstem & the skull in the same place.

A

True. the posterior cranial fossa

this makes them less susceptible to damage b/c they don’t have as long of a course.

Block 5; Week 1 (5 decks)

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