Head

Question 1

Which veins can spread infection throughout the scalp or into the intracranial sinuses?

Answer 1

The emissary veins (they are contained in the loose connective tissue of the scalp)

Question 2

What is the arterial supply of the dura mater?

How about venous drainage?

Answer 2

The middle meningeal artery. The middle meningeal veins is the venous drainage.

Question 3

What is the innervation of the dura mater?

Answer 3

Most of the meningeal dura is innervated by meningeal branches from CN V1/2/3.

Question 4

Where is the Cerebro spinal fluid located?

Where does CSF diffuses into the venous blood?

Answer 4

In the subarachnoid space.

The arachnoid project arachnoid villi (granulations) into the cranial venous sinuses, which serve as sites where CSF diffuses.

Question 5

What will cause a headache as a result of irritation of dura mater?

Answer 5

Lumber puncture. The dura mater is sensitive to pain. If the dura is irritated or stretched (after a lumbar puncture to remove CSF), a headache result where pain is referred to regions supplied by CN V.

Question 6

What can result in an epidural hemorrhage?

Answer 6

Fractures in the area of the pterion , may sever the middle meningeal artery which supplies the periosteal dura mater.

Question 7

What can cause monocular blindness?

Answer 7

Occlusion in the optic artery of the eye. This artery enters the orbit with the optic nerve CN II. (Optic artery is a branch of the internal carotid artery).

Question 8

What artery do we have to occlude in other to have a “Contralateral anesthesia of the leg”. What is the origin of this artery?

Answer 8

The Anterior cerebral artery. It’s a branch of internal carotid artery.

Question 9

What arteries in the brain are prone to hemorrhagic infarction due to hypertension or atherosclerotic occlusion?

Answer 9

The lenticulostriate arteries, they are branches off middle cerebral artery (MCA) which is a branch of the internal carotid artery.

Question 10

Which arteries in the brain are more susceptible to aneurysms?

Answer 10

Anterior communicating artery, which connect the two anterior cerebral arteries.

Question 11

If rupture, what artery will result in subarachnoid hemorrhage and possible bitemporal lower quadrantanopis due to its close proximity to the optic chiasm.

Answer 11

The anterior communicating artery.

Question 12

Occlusion of what artery will result in contralateral anesthesia of face and arm?

Answer 12

Outer cortical branches of the middle cerebral artery.

Question 13

If ruptures, which artery may cause oculomotor nerve (CN II) paralysis (droopy eyelid, eye “looks down and out”, diplopia, fixed and dilated pupil, and lack of accommodation?

Answer 13

Posterior communicating artery, which is the second most common site for aneurysm.

Question 14

Where does the facial veins drains into?

Answer 14

The facial vein provides major venous drainage of the face, and it drains into the internal jugular vein.

Question 15

What blood vessels are involved in a subdural hemorrhage?

Answer 15

The superior cerebral veins. A subdural hemorrhage is caused by a violent shaking
of the head (e.g., child abuse or car accident) and commonly occurs in alcoholics and elderly

Question 16

What blood vessels are involved in a subarachnoid hemorrhage?

Answer 16

The blood vessels involved are the cerebral arteries or the anterior or posterior communicating arteries. A subarachnoid hemorrhage is caused by a contusion or laceration injury to the brain or a berry aneurysm.

Question 17

You get into a street fight and the stab you in the area of the anterior (carotid) triangle of the neck, which nerve might have been affected?

What clinical sign will you show?

Answer 17

The facial nerve. Accidental damage during surgery to CN VII in the anterior (carotid) triangle causes distortion of the shape of the mouth.

Question 18

You were stabbed during a street fight and now you lost the ability of an oxygen chemoreceptor as well as pressure receptor. where were you stabbed and what structures were damaged?

Answer 18

In the anterior (carotid) triangle. The structures affected was the carotid body, which is an oxygen chemoreceptor. And the carotid sinus, which is a pressure receptor. Both of these are located at the bifurcation of the common carotid and their sensory information is carried to the CNS by CN IX and X.

Question 19

Wound in the occipital triangle will cause damage to what nerve? What will be the clinical finding?

Answer 19

Injury to CN XI (Accessory) within the posterior (occipital) triangle due to surgery or penetrating wound will cause paralysis of the trapezius muscle so that abduction of the arm past the horizontal position is compromised.

Question 20

Upper GI or lung cancer can cause enlarged supraclavicular lymph nodes? Where can this be palpated?

Answer 20

In the posterior (occipital) triangle.

Question 21

What innervates the cricothyroid muscle?

Answer 21

The external branch of the superior laryngeal nerve of CN X.

Question 22

What innervates all of the intrinsic muscles of the larynx?

Answer 22

The inferior laryngeal nerve of CN X (A continuation of the recurrent laryngeal nerve).

Question 23

Clinical findings of pt.s with this injury are hoarse voice, inability to speak for long periods, impaired movement of the vocal cords on the affected side. What nerve was damaged?

Answer 23

The recurrent laryngeal nerve. This is a classic example of a unilateral damage to this nerve.

Question 24

Dissection around the ligament of berry or ligation of the inferior thyroid artery during thyroidectomy can cause? which will result in?

Answer 24

Unilateral damage to the recurrent laryngeal nerve. This injury results in hoarse voice, inability to speak for long periods, impaired movement of the vocal cords on the affected side.

Question 25

Pt. presents with acute breathlesness (dyspnea), which nerve was damaged?

Answer 25

This was a bilateral damage to the recurrent laryngeal nerve. Since both vocal folds move toward the midline and close off the air passage.

Question 26

Weak voice with loss of projection result from injury to which nerve?

Answer 26

Damage to the superior laryngeal nerve. This results when ligating the superior thyroid artery during thyroidectomy. The vocal cords of the affected side appear flaccid.

Question 27

A pt. comes to your office because he is experiencing sweating while he is eating. The pt. tells you he had parotid surgery, what nerve was damaged?

Answer 27

CN V - trigeminal. This nerve may damage the auriculotemporal nerve CN V and cause loss of sensation in the auriculotemporal area of the head. Since the auriculotemporal nerve also carries postganglionic sympathetic nerve fibers to the sweat glands of the head and postganglionic parashympatheti nerve fibers to the parotid gland for salivation, it will cause sweating when eating.

Question 28

What clinical findings you will see in a person who had a stroke within the internal capsule affecting the corticobulbar tract?

Answer 28

This resutls in a contralateral paralysis of the lower face but spares the upper face. Clinical signs include inability to seal the lips or smile properly.

Question 29

What are the structures will be damages in a facial laceration near the anterior border of the masseter muscle?

Answer 29

It will cut the parotid duct of stensen and the buccal branch of CN VII. (Facial).