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NEURO > cranium ventricles and meninges > Flashcards

cranium ventricles and meninges Flashcards

0
Q

layers of meninges from inner to outer

A

PAD

pia, arachnoid and dura (periosteal and meningeal layers)

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1
Q

the three fossa of the cranial base, and contents

A

anterior - frontal lobe
middle - temporal lobe
posterior - cerebellum and brainstem

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2
Q

falx cerebri and tentorium cerebelli

A

both made from dura

the falx cerebri seperates the left and right hemispheres and runs along the interhemispheric fissure

the tentorium cerebelli covers the superior aspect of the cerebellum

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3
Q

supratentorial and infratentorial mean

A

above (cerebrum) and below (cerebellum) the tentorium cerebelli

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4
Q

potential spaces of the meninges are

A

epidural
subdural
subarachnoid

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5
Q

the middle meningeal artery is in which meningeal space and branches from which artery

A

epidural space - a branch of the external carotid artery

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6
Q

the subdural space contains what type of vasculature

A

bridging veins that drain the cerebral hemispheres and drain into dural venous sinuses, which reach the internal jugular veins by sigmoid sinuses

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7
Q

this space contains the major brain arteries and CSF

A

subarachnoid space

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8
Q

how is CSF produced

A

by a choroid plexus structure lining the ventricles of the brain - these are specialised vascular structures lined with ependymal cells

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9
Q

how is CSF reabsorbed

A

via arachnoid granulations lining the ventricles following circulation of CSF around the subarachnoid space. the CSF is reabsorbed into dural venous sinuses via these granulations.

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10
Q

ventricles of the brain are and CSF travels in what order

A

lateral ventricles
foramen of monro
third ventricles
cerebral aquaduct
fourth ventricle
lateral formaina or luschka and midline foramina of magendie
remaining subarachnoid space till reabsorption

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11
Q

cisterns are

A

spaces in the subarachnoid space which have accumulated CSF in large volumes - create areas which permite unobstructed CSF flow

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12
Q

mass effect from intracranial lesions produce

A
  • effacement of flattening of sulci
  • neurological deficits, depending on location
  • blood vessel occlusion - ischaemic infarction
  • blood vessel erosion - haemorrhage
  • vasogenic oedema (BBB damage)
  • ventricular compression - hydrocephalus
  • midline shift
  • loss of consciousness by compression of RAS
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13
Q

CEREBRAL PERFUSION =

A

MEAN ARTERIAL PRESSURE - INTRACRANIAL PRESSURE (if ICP increases CPP decreases)

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14
Q

signs of elevated intracranial pressure are

A
  • headache
  • altered mental state, irritability
  • nausea, vomiting
  • papilloedema
  • visual loss
  • diplopia - abducens palsy commonly
  • cushings triad - brady, hypertension, irregular respirations
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15
Q

herniation is a phenomenon where

A

structures creating a mass effect push intracranial structures from one compartment to another

16
Q

three most clinically relevant forms of herniation are

A

tentorial herniation - herniation through the tentorial notch
central herniation - herniation that is central and downward
subfalcine - herniation under the falx cerebri

17
Q

tentorial herniation

A
  • medial temporal lobe (uncus)

triad

  • blown pupil (CN III compression)
  • hemiplegia (cerebral peduncle compression)
  • coma
18
Q

central herniation

A

downward displacement of the brainstem

tonsilar herniation is where the cerebral tonsils (most inferior portion of cerebellum) herniate through the foramen magnum

19
Q

subfalcine herniation

A

where a unilateral mass effect can cause brain tissue to herniate under the falx cerebri - most commonly the cingulate gyrus

21
Q

epidural heamatoma

A

caused by middle meningeal artery rupture from temporal bone fracture

lens shaped and biconvex

does not spread past the cranial sutures

initial symptoms not prominent, until intracranial pressure ensures, causing mass effect symptoms and herniation

22
Q

subdural haematoma

A

rupture of the bridging veins in subdural space

crescent shaped

chronic (common in elderly b/c brain atrophy and warfarin),

acute (hyperdense to hypodense with time), haematocrit effect with continuous bleeding, poorer prognosis

23
Q

subarachnoid haemorrhage

A

characterised by the phrase “worst headache of my life”

commonest cause arterial aneurysm, then AVM

24
Q

aneurysms can be

A
  1. saccular or berry - balloon like outpouchings in arterial branch points

AComm, PComm and MCA

  1. fusiform - where main vessel becomes dilated and the wall thins out
25
Q

hydrocephalus

A

is where there is excessive CSF intracranially

communicating

  1. excessive production
  2. obstruction of flow (most common cause) in subarachnoid space
  3. reduced reabsorption

non communicating
flow obstructed in the ventricles

26
Q

normal pressure hydrocephalus

A

common in elderly

triad - urinary incontience, gait problems, mental decline

have dilated ventricles from chronic hydrocephalus

cause unknown yet suggested to be from reduced CSF reabsorption

27
Q

concussion

A

reversible impairment of neurological function from minor head trauma

  • mins to hrs post head injury
  • imaging shows normal findings
  • loss of consciousness, seeing stars, headache, dizziness and nausea
  • occassional amnesia

can experience a post concussive syndrome

28
Q

What are the main classifications for head trauma?

A
  1. Mechanism of injury
    - blunt
    - penetrating
  2. Severity measured in GCS (mild moderate and severe)
  3. Morphology
    - is is calvarial or basilar skull fracture
    - is it focal or diffuse injury
29
Q

Describe the Glasgow Coma Scale (for adults, there is a modified version for children)

A

Eye movements - best score 4
Verbal response - best score 5
Motor - best score is 6

The lowest GCS attainable is 3

14-15 is good, 8-3 is bad

GCS cannot be assessed when a person has been intubated

30
Q

What are the signs of a basilar skull fracture

A
  • periorbital ecchimosis (raccon eyes)
  • conjunctival haemorrhage
  • bruising behind ear (post auricular)
  • haematothypanom
  • CSF rhinorrhoea, otorrhoea
31
Q

How can you confirm CSF in suspected rhinorrheoa or otorrhoea

A
  • compared glucose level with that in the serum

- test for beta-2 transferrin (a marker specific for CSF)

32
Q

Diffuse axonal haemorrhage

A
  • occurs from shear and acceleration forces (during a head injury)
  • the forces cause axonal injury which cause cytoskeletal damage which breaks down the BBB, causing cell swelling and oedema and decreased [ATP] to injured cells
  • microscopically they appear as spherical axonal retraction balls
  • can be seen on MRI but not definitively

NEURO (18 decks)

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