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Neuro Exam 1 > Dural Sinuses, Meninges, and Vasculature > Flashcards

Dural Sinuses, Meninges, and Vasculature Flashcards

1
Q
  • Cranial meninges
A
  • Dense regular CT layers (3)
  • Separate soft tissue of brain from cranial bones
  • Contain and circulate CSF
  • Parts form some of the veins
    *
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2
Q
  • What are the 3 layers of the cranial meninges from superficial to deep?
A
  • Dura mater
  • Arachnoid mater
  • Pia mater
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3
Q
  • Dura Mater
A
  • Two fibrous layers
  • Strongest
  • Two layers:
    • Periosteal layer-more superficial layer, attaches to periosteum
    • Meningeal layer-deep to periosteal layer
  • Fused with periosteal layer; except in two layers separate to form large blood-filled spaces called dural venous sinuses
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4
Q
  • Arachnoid
A
  • Immediately internal to the dura mater
  • Collagen and elastic fibers=arachnoid trabeculae
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5
Q
  • Space between the arachnoid and overlying dura mater is called the _ space
  • Space immediately deep to the arachnoid space is the _ space
A
  • Subdural
  • Subrarachnoid
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6
Q
  • Pia Mater
A
  • Innermost layer
  • Follows sulci and gyri-adhered to actual brain
  • Delicate thin layer of CT
  • Means gentle mother-so here’s a picture of my mom
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7
Q
  • Cranial Dural Spta
A
  • _ layer of the dura mater extends as flat partitions (_) deep into cranial cavity at four locations
  • Membranous partitions separate specific parts of the brain and provide additional stabilization and support to the entire brain
    • Falx cerebri
    • Tentorium cerebelli
    • Falx cerebelli
    • Diaphragma Cerebelli
  • In the septa are dural venous sinuses (superior and inferior sagittal sinus, straight sinus, sigmoid sinus, and transverse sinus)
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8
Q
  • Dural Septa and Dural Venous Sinuses
A
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9
Q
  • Arterial supply to the meninges comes from the _ artery which is a branch of the external carotid a.
  • What are the sub-branches of the arterial supply to the meninges
  • This artery enters the skull via _
A
  • Middle meningeal a.
  • Frontal (anterior) branch
  • Parietal (posterior) branch
  • Foramen spinosum
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10
Q
  • Innveration of the meninges
A
  • Middle frontal portion of brain-Opthalmic N (V1)
  • Lateral frontal portion of brain- Maxillary N (V2) and Mandibular N (V3)
  • Posteromedial-Opthalmic N (V1) and Cervical Spinal Nerves (Deeper-C2,C3)
  • Posterolateral-Mandibular N (V3)
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11
Q
A
  1. Superior sagittal sinus
  2. Inferior sagittal sinus
  3. Straight sinus
  4. Confluence of the sinuses
  5. Occipital sinus
  6. Sigmoid sinus
  7. Cavernous sinus
  8. Anterior intercavernous sinus
  9. Posterior intercavernous sinus
  10. Sphenoparietal sinus
  11. Superior petrosal sinus
  12. Inferior petrosal sinus
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12
Q
A
  1. Tentorium cerebelli
  2. Diaphragma sellae
  3. Falx cerebri
  4. Falx cerebelli
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13
Q
  • Cavernous sinus associated structures
A
  • CN III, IV, first part of V, VI
  • Internal carotid a.
  • Pituitary gland
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14
Q
  • What nerve is less tightly compacted in the cavernous sinus and is more prone to damage with a thrombus of the cavernous sinus and internal carotid a.?
A
  • Abducent n. (CN VI)
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15
Q
  • The internal carotid artery has what three parts in the brain
A
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16
Q
  • Cerebrospinal fluid
    • Functions
    • Where is it formed
    • What does it contain
A
  • Buoyancy
  • Protection
  • Environmental stability
  • Formed in choroid plexus in each ventricle
  • Produced by secretion from ependymal cells that originate from the blood plasma
  • More Na+, H+, and Ca2+ but less K+ than plasma
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17
Q
  • CSF drains into the _ and then into the dural venous sinus, which then drains into the internal jugular v.
A
  • Arachnoid granulations
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18
Q

_ joins the subclavian vein to form the brachiocephalic vein posterior to medial end of clavicle

A
  • Internal jugular v.
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19
Q
  • Internal jugular v.
  • Emerges thru _ as continuation of sigmoid sinus
  • Descends behind and lateral to _ inside the carotid sheath
A
  • Jugular foramen
  • Internal carotid a.
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20
Q
  • What LNs are located in the I region of the cervical LNs?
A
  • Submental and submandibular LNs
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21
Q
  • What LNs are located in region II of the cervical LNs?
A
  • Deep cervical LNs (upper lateral group)
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22
Q
  • What LNs are located in the III region of the cervical LNs?
A
  • Deep cervical LNs (middle lateral group)
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23
Q

What LNs are located in the IV region of the cervical LNs?

A
  • Deep cervical LNs (lower lateral group)
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24
Q
  • What LNs are located in the V region of the cervical LNs?
A
  • LNs of the posterior cervical triangle
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25
Q
  • What LNs are located in the VI region of the cervical LNs?
A
  • Anterior cervical LNs
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26
Q
  • Cervical LNs
A
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27
Q
  • At what two sites do the lymphatic pathways in the cervical region intersect?
  • What is clinically significant if these LNs are affected compared to peripheral LNs?
A
  • Jugulofacial venous junction
  • Jugulosubclavian venous junction
  • Could indicate malignancy rather than localized pathology
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28
Q
  • What are the two bulbs of the internal jugular v?
A
  • Superior bulb
  • Inferior bulb (bicuspid valve above)
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29
Q
  • _ assists in draining the cavernous sinus; leaves thru anterior part of jugular foramen and joins the internal jugular v below the superior bulb
A
  • Inferior petrosal sinus
30
Q
  • _ is formed by union of supraorbital and supratrochlear veins at medial canthus to form the angular v
  • Communicates with the cavernous sinus thru superior opthalmic v
  • Descends on the face posterior to the facial a. to lower border of mandible
  • Joined by anterior division of retromandibular v.oins pterygoid plexus thru deep facial v
A
  • Facial v
31
Q
  • _ is formed by the union of superficial temporal and maxillary veins
  • Passes downwards in substance of parotid gland
  • Has two divisions
A
  • Retromandibular v.
32
Q

What are the two divisions of the retromandibular vein?

A
  • Anterior
    • Joins the facial v
  • Posterior division
    • Pierces deep fascia and joins posterior auricular to form external jugular v.
33
Q
  • _ v passes backward between the sphenomandibular ligament and neck of the mandible
  • Unites with the superficial temporal v to form the retromandibular v.
A
  • Maxillary v
34
Q
  • Pterygoid plexus
A
  • Small veins around and within laeral pterygoid muscle in infratemporal region
  • Drain into maxillary veins which join superficial temporal vein to form retromandibular
  • Acts as a peripheral pump-aids venous return by pumping action of muscle every time mouth is opened

Yawning-prolonged and forcible contraction of lateral pterygoid to open mouth, accompanied by contraction of diaphragm and stretching of limbs-reflex triggered by venous stagnation

35
Q

_ veins

Drain pharyngeal plexus on outer surface of pharynx

End in internal jugular v, facial, lingual or superior thyroid veins

A
  • Pharyngeal veins
36
Q
  • _ leaves the superior pole of the thyroid gland and empties in the face or internal jugular
  • _ is short and wide, passes thru middle of pole directly into internal jugular v
  • _ joins internal jugular, but more often vertebral or posterior auricular
A
  • Superior thyroid v.
  • Middle thyroid v.
  • Occipital v.
37
Q
  • _ vein starts below chin, passes beneath platysma to suprasternal notch
A
  • Anterior jugular v.
38
Q
  • _ vein
    • Begins behind angle of mandible by union of posterior auricular and posterior division of the retromandibular veins
    • Descends obliquely, deep to platysma, receives posterior external jugular v
    • Pierces deep fascia just above clavicle and drains into the subclavian v.
A
  • External jugular v
39
Q

Summary of veins

A
40
Q
  • What are the branches off of the aortic arch?
A
  • Right
    • Brachiocephalic trunk
      • Right common carotid a.
      • Right subclavian a.
    • Left
      • Left common carotid a.
      • Left subclavian a.
41
Q
  • Where is the 1st part of the subclavian a. located (anatomically speaking)
  • Where is the 2nd part of the subclavian a. located
  • Where is the 3rd part of the subclavian a. located
A
  • Medial to the anterior scalene m.
  • Behind the anterior scalene m.
  • Lateral border of anterior scalene m. to first rib
42
Q
  • What are the branches off of the first part of the subclavian
A
  • Vertebral a.
  • Thyrocervical trunk
    • Suprascapular a. (supplies supraspinatus and infraspinatus m.)
    • Transverse cervical a. (Supplies trapezius m.)
    • Inferior thyroid a.
    • Ascending cervical a.
  • Internal thoracic a.
43
Q
  • What are the branches off the second part of the subclavian
A
  • Costocervical trunk
    • Supreme intercostal a.
    • Deep cervical a.
44
Q
  • What are the branches off the third part of the subclavian
A
  • Dorsal scapular a. (supplies rhomboid m. and levator scapulae m.)
45
Q
  • Common carotid a. branches into what?
A
  • External carotid a.
  • Internal carotid a.
  • Carotid sinus
    • Superior to bifurcation on internal carotid a.
46
Q
  • Baroreceptors on the carotid sinus are innervated by what cranial n.?
A
  • Glossopharyngeal n (CN IX)
  • Indirectly modulates activity of the sympathetic and paraympathetic response to blood pressure
47
Q
  • Identify the branches of the external carotid a.
A
  1. Superior labial a.
  2. Superior thyroid a.
  3. Superficial temporal a.
  4. Transverse facial a.
  5. Maxillary a.
  6. Posterior auricular a.
  7. Ascending pharyngeal a.
  8. Occipital a.
  9. Facial a.
  10. Lingual a
  11. External carotid a.
48
Q
  • What pneumonic can be used to remember the branches of the external carotid a.?
A
  • Some anatomists like freaking out poor medical students
  • S-superior thyroid a.
  • A-Ascending pharyngeal a.
  • L-Lingual a.
  • F-Facial a.
  • O-Occipital a.
  • P-Posterior Auricular a.
  • M-Maxillary a.
  • S-Superficial temporal a.
49
Q
  • Identify the following arteries
A
  1. Infrahyoid a.
  2. Superior laryngeal a.
  3. Sternocleidomastoid branch of the superior thyroid a.
  4. Superior thyroid a.
50
Q
  • What vascular structure is shown in the following image
A
  • Ascending pharyngeal a.
    • Supplies pharynx musculature
51
Q
  • _ travels obliquely upwards and medially to greater horns of hyoid bone
  • Curves down and forward, passing beneath stylohyoid and digastric m.
  • Travels medially to hyopoglossal n.
  • Runs deep to hyoglossus m.
A
  • Lingual a.
52
Q
  • What are the terminal branches of the lingual a.?
A
  1. Deep lingual a
    1. Goes to base of tongue
    2. Runs with lingual n
    3. Lingual n-superficial to hyoglossus m
    4. Lingual a-deep to hyoglossus m
  2. Sublingual a
    1. Sublingual gland and oral floor
  3. Lingual a
53
Q
  • What artery:
    • Arises in carotid triangle
    • Runs beneath digastric and stylohyoid m (superficial to hypoglossal n)
    • Enters groove on posterior submandibular gland
    • Curves over body of mandible
    • Runs obliquely past the nose
A
  • Facial a.
54
Q
  • What are the branches of the facial a.?
A
  • Cervical branches
    • Ascending palatine a.-pharyngeal wall, soft palate, pharyngotympanic tube
    • Tonsillar branch-palatine tonsils
    • Submental a and glandular branches
  • Facial branches
    • Inferior labial a.
    • Superior labial a.
    • Lateral nasal branch
    • Angular a. (terminal branch)
55
Q
  • What is the relationship between the facial artery and vein?
A
  • Facial artery sits anterior to the facial v and is more tortuous
56
Q
  • What artery:
    • Arises in carotid triangle from posterior aspect of external carotid
    • Runs upward and posterior
    • Terminal portion runs with greater occipital n.
A
  • Occipital a
57
Q
  • What artery:
    • Arises above digastric and stylohyoid m.
    • Ascends posteriorly beneath the parotid gland along lateral side of head behind the ear
    • Runs with posterior auricular n.
  • What are the branches of this artery?
A
58
Q
  • What are the branches of the maxillary a.?
A
  • Middle meningeal a.
59
Q
  • What are the branches of the mandibular part of the maxillary a?
A
60
Q
  • Epidural hematoma
A
  • Tear in the middle meningeal a. external to the dura mater
61
Q
  • Subdural hematoma
A
  • Tear of middle meningeal a. deep to the dura mater
62
Q
  • What are the portions of the pterygoid part of the maxillary a.?
A
63
Q

Pterygopalatine part of maxillary a

A
64
Q
  • Which artery:
    • Begins between TMJ and the ear
    • Enters temporal fossa
    • Terminates by dividing into frontal and parietal branches
    • Branches run close to auriculotemporal n
A
  • Superficial temporal a
65
Q
  • What are the branches of the superficial temporal a.?
A
  • Transverse facial a
  • Middle temporal a
  • Anterior auricular
  • Terminal branches
    • Frontal a
    • Parietal a
66
Q
  • The internal carotid a. does not branch in the neck, but does enter cranial cavity thru _ part of temporal bone via _ canal
  • It then courses anteriorly thru _ sinuses and runs in _ groove
  • What are its branches?
A
  • Petrous part of temporal bone via carotid canal
  • Thru cavernous sinuses and runs in carotid groove
  • Branches:
    • Opthalmic a.
    • Anterior cerebral a.
    • Middle cerebral a.
67
Q
  • Vertebral a. (branches off 1st part of subclavian a.)
    • Runs thru _
    • Takes a sharp turn between what two cervical vertebrae?
    • This artery stretches with what movements?
A
  • Vertebral foramen
  • C1 and C2
  • Rotation and extension
68
Q
A
  1. Posterior communicating artery
  2. Pontine arteries
  3. Anterior spinal a.
  4. Posterior cerebral a.
  5. Superior cerebellar a.
  6. Basilar a.
  7. Anterior inferior cerebellar a.
  8. Vertebral a.
  9. Posterior inferior cerebellar a.
69
Q
  • Vertebrobasilar insufficiency
A
  • Decreased posterior circulation due to intermittent vertebral a. occlusion
    • From atherosclerosis
    • During head rotation or extension
  • Sx
    • Syncope, vertigo, dizziness
    • Double vision, loss of vision
    • Numbness or weakness in hands/feet
    • Slurred speech
    • NV
    • Loss of coordination or weakness
  • Risk factors
    • Smoking
    • HTN
    • Hyperlipidemia
    • Diabetes
    • Obesity
    • > 50 years old
    • Fam history
  • Dx
    • H&P
    • CV and Neuro exam
    • CT angiogram/MRA
  • Tx
    • Diet changes
    • Cessation of smoking
    • Lose weight
    • Increase activity levels
    • Bypass surg or endarterectomy
    • Bloodthinners
    • Meds for diabetes, HTN,etc
70
Q
  • Subclavian Steal Syndrome
A
  • Proximal stenosis or occlusion of subclavian a,
  • Blockage causes reverse flow thru vertebral a of affected side to supply blood to upper extremity (decreases blood flow to brain)
  • Sx
    • Presyncope or syncope
    • Different BPs in upper extremities
    • Neurologic deficits or memory problems
  • Causes
    • Atherosclerosis
    • Cervical rib
  • Dx
    • Doppler US
    • CT Angiographt
  • Tx
    • Stent and Balloon angioplasty
    • Endarterectomy

Neuro Exam 1 (14 decks)

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