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Neuro Block 5 > Gross Anatomy Day 2 > Flashcards

Gross Anatomy Day 2 Flashcards

1
Q

What regions are in the supratentorial compartment?

A

Telencephalon and diencephalon

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2
Q

What cranial nerves are in the supratentorial compartment

A

I and II

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3
Q

What actions/functions/behaviors are associated with the supratentorial compartment?

A
  • awake and oriented
  • olfactory and visual systems
  • cognition and language
  • emotion and behavioral regulation
  • hypothalamic and pituitary functions
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4
Q

What are the regions in the infratemporal compartment?

A

Brainstem and cerebellum

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5
Q

What part of the brainstem is in the infratentorial compartment

A

CN 3-12

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6
Q

What major part of the brain is in the infratentorial compartment and what does it do?

A

Cerebellum, motor coordination

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7
Q

What is contained in the vertebral compartment

A

Spinal cord, dorsal and ventral roots

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8
Q

When motor and somatosensory exams re conducted, what compartment is being tested?

A

Vertebral compartment

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9
Q

What compartment is responsible for reflexes

A

Vertebral compartment

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10
Q

What causes herniation syndrome?

A

Various intracranial masses

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11
Q

What are 4 types of cranial herniations

A
  • subfalcine herniation
  • central herniation
  • uncal transtentorial herniation
  • tonsillar herniation
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12
Q

Herniations: effects on brain tissue vs dural partitions

A
  • initially, it is the brain tissue that is displaced and injured
  • with progression of mass effect, dural partitions can be displaced as well
  • in radiology, shifts in dural partitions and brain can be detected
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13
Q

What could cause a midline shift

A

Supratentorial mass, causing subfalcine herniation

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14
Q

What is the average normal value for intracranial pressure?

A

<20cm (200mm) H20

<15cm (150mm) Hg

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15
Q

How is intracranial pressure measured?

A
  • lumbar puncture (subarachnoid space around cauda equina)

- neurosurgical insertion of intracranial monitors/ catheters

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16
Q

Contra indications for lumbar punctures

A
  • suspected increased supratentorial pressure (can cause herniations!)
  • infection or mass in the path of manometer needle insertion
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17
Q

What are some causes of intracranial pressure

A
  • hydrocephalus (too much CSF)
  • brain edema (accumulation of water content)
  • hemorrhage
  • tumor or other mass
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18
Q

Symptoms of increases intracranial pressure

A
  • headache
  • nausea and vomiting (vomiting can occur in the absence of nausea)
  • impaired consciousness
  • skull (bulging fontanelles)
  • increases systemic blood pressure
  • papilledema
19
Q

Increases intracranial pressure causes rippled effect along perimeter (elevation) and loss of sharp contours, due to congestion and swelling of axons

A

Papilledema

20
Q

Sensory (pain) innervation of dura, falx, tentorium

A

Mostly trigeminal nerve (CN5), some vagus (CN10), cervical nerves

21
Q

Meningeal irritation syndrome

A
  1. Headache/pain
  2. Neck stiffness (nuchal rigidity)
  3. Impairment or loss of consciousness
22
Q

Mechanism of neck stiffness in meningeal irritation syndrome

A

Might be cervical spinal reflex circuit: sensory input activates motonerons and increases muscle tone in neck

23
Q

Various potential causes or sources of meningeal irritation syndrome

A
  • inflammation
  • infection (meningitis)
  • pressure (bleeding, growing intracranial mass)
24
Q

Does intracranial pressure have to be present to have meningeal irritation syndrome?

A

No

25
Q

Kernigs test and sign

A
  1. Passive flexion of hip
  2. Passive extension of knee
  3. Kernigs sign is pain with knee extension
26
Q

What is kernigs sign

A

Pain with knee extension

27
Q

What are the physical exam tests and signs of meningeal irritation syndrome

A
  • kernigs

- brudzinskis

28
Q

Brudzinskis test and sign

A
  1. With passive flexion of neck
  2. Patient feels pain in neck
  3. The sign is the spontaneous, on voluntary hip and knee flexion
29
Q

What is brudzinskis sign

A

Spontaneous involuntary hip and knee flexion

30
Q

What is the reflexive response to neck flexion and pain in brudzinskis test mean?

A

Possibly an unconscious compensatory response to reduce dural tension and pain induced by the neck flexion

31
Q

Clinical presentation of CNS infections

A
  • diffuse neurological signs (meningeal irritation or increase intracranial pressure)
  • focal neurological signs (abscesses and parasitic cysts can lead to focal or multifocal lesions and signs
32
Q

What can lead to focal or multifocal lesions and signs of the CNS?

A

Abscesses and parasitic cysts

33
Q

Diagnostic approach for CNS infections

A
  • history
  • physical exam
  • knowledge of micro
  • lab tests
  • neuroimaging
34
Q

Immune system in CNS

A
  • few immune cells within CNS

- specific types of brain cells act as immune cells

35
Q

Barriers to CNS infection

A

Specific anatomical or physiological barriers

  • infection gets in when the barriers are disrupted (trauma, immunodeficiency)
  • some direct and open routes do exits
36
Q

Viral entry into CNS via PNS neurons

A
  • some viruses can directly enter PNS through axon terminals
  • once inside, viruses can be transported backwards to the cell body in a ganglion, spinal cord, or brain.
  • some can go further back across synapses and thus spread further (trans synaptic spread, rabies)
37
Q

What are the 3 potential channels for entry into the CNS that do not include traumatic breach of skull, or disruption of blood brain barrier or blood CSF barrier

A
  1. Emissary veins (from scalp Gino superior sagittal sinus)
  2. Veins from face to cavernous sinus
  3. Cribiform plate possibly
38
Q

Infection of dura or arachnoid and pia?

A

Meningitis

39
Q

Infection of parenchyma of brain or spinal cord

A

Encephalitis

40
Q

Why is the meningeal artery point of potential traumatic injury and epidural hemorrhage?

A

It’s branches cross multiple suture lines

41
Q

Cerebral veins drain via ________ into superior sagittal sinus

A

Bridging veins

42
Q

Typically caused by a tear in the bridging veins at the dura-arachnoid interface

A

Subdural hemorrhage

43
Q

Most common origin of subarachnoid hemorrhage

A

Aneurysms

44
Q

Symptoms of subarachnoid hemorrhage

A
  • diffuse neurological signs
  • meningeal irritation signs
  • increase intracranial pressure
  • detectable by lumbar puncture and neuroimaging

Neuro Block 5 (11 decks)

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