Exam 4 - Meninges and Spine Flashcards
Three layers of mengines?
Dura
Arachnoid
Pia
How many Dura layers in brain and spine?
Brain=2
Spine=1
Which Dura layer on bone, which on CNS?
Outer layer=bone
Inner layer=CNS
Does Arachnoid layer adhere to Pia
No
What is innermost meningeal layer?
Pia
What areas where two dura layers separate?
Dura Sinuses
Where do Dura Sinuses eventually drain into?
Internal Jugular Vein
Where and is Epidural Space? What pathologies?
Dura-Skull interface. Epidural hemorrhage from Middle and Epidural Abscess
Which artery responsible for Epidural Hemorrhage?
Middle Meningeal Artery
Where is Sub-Doral Space? What contains? What pathology?
Dura-Arachnoid Interface. Contains blood vessels supply brain. Subdural Hemorrhage.
What causes Subdural Hemorrhage?
Rupture of cerebral veins passing from brain to venous sinus
Where is Sub-arachnoid Space? What does it contain? Pathology?
Arachnoid-Pia interface. Contains CSF! Subarachnoid Hemorrhage.
Where is CSF contained?
Subarachnoid Space (Arachnoid-Pia interface)
Where does Subarachnoid Hemorrhage occur? Due to what?
Subarachnoid Space (Arachnoid-Pia interface). D/T “Berry Anuerysms”. “Worst HA ever!”
What does CSF fill and where does t flow into?
Fills ventricles, flows into Subarachnoid Space
Lateral Ventricles to Third Ventricle via?
Foramen of Monroe
Third Ventricle to Fourth Ventricle via?
Cerebral Aqueduct
Fourth Ventricle to Subarachnoid Space via?
Foramen of Mag and Luk
CSF in SAS goes to which two places?
90% to Arachnoid Villi/Granulations
10% to Interstitial Space via perivascular spaces
Role of CSF?
Provides stable environment for CNS. Cushions and insulated brain from internal forces. Removes metabolic waste, gas exchange.
CSF made by what two things?
70% in Choroid Plexus of Ventricles
20-30% by Ependymal Cells
Total circulating CSF volume?
150ml
Rate formed CSF hour and day?
Hour=20-25mL
Day=550mL
CSF turns over how many times each day
3-4
Does rate of CSF production change due to intracranial pressure?
No
Arachnoid Villi open when?
When SAS pressure is 1mmhG more than venous sinus
Open pressure of LP on left side?
8-15mmHg
Open pressure of LP sitting?
14-22mmHg
Ph, Potassium, glucose, protein, and cholesterol lower in CSF or Blood Plasma?
CSF
PCO2, Cl, and Na higher in CSF or Blood Plasma?
Higher in CSF.
Where is Interstitial Fluid (ISF)?
Within and surrounds CNS cells (neurons and glia)
ISF drains out from where to where?
From Perivascular spaces to SAS -or- out of ependymal walls into ventriclular system pathways
Acute Phase of spinal shock lasts how long? Is it permanent?
2-3 weeks. Rarely permanent.
Flaccid paralysis, areflexia, bowel/bladder dysfunction, hypotension, and Horner’s Syndrome are from which spinal cord injury phase?
Acute Phase
Subacute Phase of SCI when?
2-3 weeks after injury
Hyperreflexia, hypertonicity, spastic paralysis, and orthostatic hypotension from which phase of SCI?
Subacute Phase
Extreme Hypertension and Bradycardia due to what?
Autonomic Dysreflexia
SCI above T-5 can cause what?
ANS Hyperresponsiveness, sympathetics fireing extensively raising BP and lowering HR
Autonomic Dysreflexia due to injury where?
SCI above T-5
Autonomic Dysreflexia very often due to what? Treatment?
Full bladder or bowels. Sit up, drain bladder/bowels.
All levels of SCI injury impacts what?
Bladder and bowel control
T12 injury causes paraplegia to what?
LE
T2-T4 injury causes paraplegia to what?
LE and Trunk. Stable sitting/posture hard
C6-C7 injury causes quadriplegia. What is maintained?
Proximal UE maintained
C1-C4 injury causes loss of what?
Everything, including respiratory loss
Sacral/Lower Lumbar injury causes varying what?
Varying paraplegia. Trunk, UE intact. Walk with devices.
In Anterior Cord Syndrome remains intact?
Proprioception, discriminating touch, vibration sense
In Central Cord Syndrome UE or LE which is affected more? What is the sensory disruption described like?
UE loss more than LE.
“Cape-like” sensory disruption
What is the most common loss in Central Cord Syndrome?
Pain and temp loss
In Brown-Sequard Syndome what is the damage? What sides for motor and sensory loss?
Hemisection.
Ipsilateral loss of proprioception, discrimination touch, and vibration.
Contralateral loss of pain and temp
Which SCI hasIpsilateral loss of proprioception, discrimination touch, and vibration but Contralateral loss of pain and temp?
Brown-Sequard Syndrome
Which artery supplies the anterior 2/3 of the spinal cord? From where?
Anterior Spinal Artery.
From R/L vetebral arteries.
R/L Posterior Spinal Arteries from where? What to segmental branches supply?
From R/L PICA. Segmental branches supply anterior spinal artery at each level.
Upper Motor Neuron Lesion affects where, hyper/hypo, and muscle?
CNS, hyper, slow muscle atroply
Lower Motor Neuron Lesion where, hypo/hyper, muscle?
PNS, hypo, fast atrophy. Radiculopathy.
MS and ALS due to upper motor neuron, lower motor neuron, or mixed?
Mixed.
