Lecture 2 Flashcards

1
Q

What percentage of the intracranial vault does each component make? Brain, Blood and CSF

A

Brain: 80 - 85%
Blood: 5 - 10%
CSF: 10 - 15%

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2
Q

What are the 2 main blood supplies to the brain?

A

Bilateral Carotid arteries

Bilateral Vertebral arteries

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3
Q

Where does the left carotid artery arise from?

A

The aortic arch

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4
Q

Where does the right carotid after arise from?

A

The Innominate Artery

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5
Q

What do the carotid arteries bifurcate into?(2)

A
  1. External carotid artery

2. Internal carotid artery

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6
Q

Where does the internal carotid artery enter the skull?

A

At the base of the skull

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7
Q

Where does the External carotid artery enter the skull?

A

It does NOT enter the skull, it remains superficial to the skull

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8
Q

What 3 main areas do the internal carotid arteries supply?

A
  1. Circle of Willis
  2. Ophthalmic artery (supplies the eye)
  3. Bifurcates into the anterior & middle cerebral arteries
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9
Q

What arteries arise from the subclavian arteries and supply the Circle of Willis?

A

The vertebral arteries

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10
Q

Where do the vertebral arteries arise from?

A

Subclavian arteries

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11
Q

What part of the brain do the vertebral arteries supply?

A

Circle of Willis

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12
Q

Describe how the venous blood of the brain drains?

A

Drains into the VENOUS SINUSES which lie between the layers of the DURA MATER & drain into the INTERNAL JUGULAR VEIN

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13
Q

Describe 4 important aspects of venous sinuses of the brain:

A
  1. Valveless
  2. Blood can flow back & forth
  3. Negative pressure (air embolism)
  4. Little influence by autonomic system
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14
Q

Describe why there brain is subject to air embolisms?

A

Venous sinuses have negative pressure, which can lead to air embolism

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15
Q

What do the meninges cover (2) and what do the consist of (3)?

A
  • Covers BRAIN & SPINAL CORD

- Consists of DURA MATER, ARACHNOID MEMBRANE, PIA MATER

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16
Q

The ____A_____ is anchored to the brain by ____B_____, which forms the _____C_____.

A

A. Pia mater
B. Astrocytes
C. Blood-brain barrier

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17
Q

The Blood-brain barrier allows passage/transport of: (4 - with examples)

A
  1. Small molecules (H2O, O2, CO2)
  2. Lipophilic molecules (EtOH, heroin)
  3. Passive transport of glucose
  4. Active transport of amino acids/NT precursors
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18
Q

The blood-brain barrier PREVENTS the passage of: (2)

A
  1. Large molecules (dopamine)

2. Charge (ionized) molecules

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19
Q

What does the dura mater consist of? What is between these layers?
What is the function of the dura mater?

A
  • Consists of outer & inner layer
  • Dural Sinus between the layers
  • Drains the CSF
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20
Q

List the layers from the brain to the skull:

A
  1. Brain
  2. Pia mater
  3. Subarachnoid space
  4. Arachnoid membrane
  5. Dura mater
  6. Skull
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21
Q

Where is an epidural hematoma located? What is usually the artery of origin?

A
  • Bleeding between the skull & dura mater

- Usually originating in meningeal arteries

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22
Q

Where is a subdural hematoma located? What is usually the artery of origin?

A
  • Bleeding between the dura & arachnoid mater

- Usually originating from tears in BRIDGING VEINS

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23
Q

Where is a subarachnoid hematoma located? What is usually the cause?

A
  • Bleeding between the arachnoid membrane & Pia mater

- Usually from a ruptured cerebral aneurysm

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24
Q

Is a subarachnoid hemorrhage the most common cause of stroke?

A

No, it is less common. It is a neurological emergency

25
What produces CSF and where?
- Produced by the Choroid Plexus | - Produced in the cerebral ventricles
26
What does CSF surround and what is it’s 3 main functions?
- Surrounds the brain & spinal cord 1. Cushions 2. Supports 3. Facilitates transport of nutrients
27
What is roughly the total volume of CSF? How much CSF is produced daily?
- Roughly 150 mL | - Roughly 500 mL produced daily
28
What is Cranial Nerve VII?
Facial nerve
29
What 2 important muscles does CN VII innervate?
1. Muscles of facial expression (motor) | 2. Orbicularis Oculi
30
When is CN VII frequently monitored? Examples?
- During surgery around the face | - Parotidectomy, acoustic neuroma, cochlear implant
31
What is CN IX?
Glossopharyngeal nerve
32
What 3 important structures does CN IX provide SENSORY innervation to?
1. Baroreceptors of carotid sinus 2. Chemoreceptors of carotid body 3. Posterior oral mucosa (gag reflex)
33
What important structures does CN IX provide MOTOR innervation to?
The pharynx (swallowing)
34
What can likely happen during CEA?
CN IX can be stimulated via the baroreceptors of the carotid sinus —> leading to bradycardia and hypotension
35
What is CN X? What 3 forms of innervation does it provide?
- Vagus nerve 1. Sensory 2. Motor 3. Parasympathetic
36
Which parts of the pharynx does CN X supply? (3)
1. Pharyngeal muscles 2. Mucous membranes 3. Palate
37
Which part of the Larynx does CN X supply? (2)
1. Superior laryngeal nerve | 2. Recurrent laryngeal nerve
38
Which nerve innervates the cricothyroid muscle? What is the function of the cricothyroid muscle?
- The external branch of the SLN | - Tenses and ADDUCTS the vocal cords
39
What happens with injury to the external SLN?
Changes in voice quality, but generally NOT dangerous
40
What does the RLN innervate?
All of the INTRINSIC muscles of the larynx EXCEPT for the cricothyroid muscle
41
A unilateral RLN injury produces ____A____ vocal cord paralysis, affecting the _____B_____ muscle. Resulting in a ____C____ position of the affected cord, which causes postoperative _____D_____
A. Abductor vocal cord paralysis B. Posterior cricoarytenoid muscle C. Paramedian position D. hoarseness
42
Bilateral RLN injury results in __A__ paralysis, which can manifest as ___B___ vs. ___C___. Symptoms include ___D___ and often requires ____E____ or ___F___.
``` A. Bilateral vocal cord paralysis B. Partial airway obstruction C. Complete airway obstruction D. Respiratory distress with stridor E. Emergent reintubation F. Tracheostomy ```
43
Which systems does CN X provide parasympathetic innervation to? (3)
1. Heart 2. Lungs 3. GI system
44
Which part of the heart does CN X provide parasympathetic innervation to?(2) What does this stimulation result in?
- Innervation to sino-atrial and atrio-ventricular nodes of the heart - Stimulation causes reduction in resting heart rate, & are constantly active
45
What aspect does of the lungs does CN X provide parasympathetic innervation to? What is the result of stimulation? (2)
- parasympathetic to the pulmonary plexus | - Stimulation causes VASODILATION and BRONCHOCONSTRICTION
46
What aspect of the GI system does CN X provide parasympathetic innervation to? What does stimulation result in?
- Innervates the majority of ABDOMINAL ORGANS | - Stimulates SMOOTH MUSCLE CONTRACTION & GLANDULAR SECRETIONS in these organs
47
What can vagal stimulation during GI surgery & endoscopy lead to?
Significant bradycardia and even asystole
48
What is CN I and it’s function?
- Olfactory | - Smell
49
What is CN II and it’s function?
- Optic | - Sight
50
What is CN III and it’s function?
- Oculomotor | - Eyelid & eyeball movement; pupil and lens adjustment
51
What is CN IV and it’s function?
- Trochlear | - Moves eyeballs
52
What is CN V and it’s function?
- Trigeminal | - Facial muscles (chewing) and facial sensation
53
What is CN VI and it’s function?
- Abducens | - Moves eyeballs
54
What is CN VII and it’s function?
- Facial | - Taste, tears, saliva, facial expressions
55
What is CN VIII and it’s function?
- Vestibulocochlear | - auditory
56
What is CN IX and it’s function?
- Glossopharyngeal | - Swallowing, saliva, taste
57
What is CN X and it’s function?
- Vagus | - Control of PNS (heart, lungs, GI)
58
What is CN XI and it’s function?
- Accessory | - Movement of Head & shoulder; swallowing
59
What is CN XII and it’s function?
- Hypoglossal | - Tongue muscles - speech and swallowing