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DCCJP > M1 Anatomy > Flashcards

M1 Anatomy Flashcards

1
Q

Cranial Nerve Names

A

CN 0: Terminal

CN I: Olfactory

CN II: Optic

CN III: Oculomotor

CN IV: Trochlear

CN V: Trigeminal

CN VI: Abducens

CN VII: Facial

CN VIII: Vestibulocochlear

CN IX: Glossopharyngeal

CN X: Vagus

CN XI: Accessory

CN XII: Hypoglossal

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2
Q

Cranial Nerves of the Midbrain (mesencephalon)

A

Source of:

CN III: Oculomotor

CN IV: Trochlear

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3
Q

Cranial Nerves of the Pons

A

Source of:

CN V: Trigeminal

CN VI: Abducens

CN VII: Facial

CN VIII: Vestibulocochlear

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4
Q

Cranial Nerves

of

Medulla Oblongata

A

Source of:

CN IX: Glossopharyngeal

CN X: Vagus

CN XI: Accessory

CN XII: Hypoglossal

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5
Q

Cranial Nerve Origins

A
  • Brain: (3)
    • 0 I II
  • Midbrain: (2)
    • III IV
  • Pons: (4)
    • V VI VII VIII
  • Medulla Oblongata: (4)
    • IX X XI XII
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6
Q

Olfactory Nerve

A
  • Cranial Nerve I
  • Sensory nerve fibers of olfaction
  • Capable of some regeneration if damaged
  • Technically part of CNS
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7
Q

Olfactory Nerve Pathway

A
  1. Olfactory Mucosa
  2. Cribriform plate of ethmoidal bone
  3. Synapse on Olfactory bulbs
  4. Olfactory Tract
  5. Brain
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8
Q

Optic Nerve

A
  • Cranial Nerve II
  • Sensory nerve transmitting visual information
  • Technically part of CNS
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9
Q

Optic Nerve Pathway

A
  1. Optic disc of retina
  2. Optic nerve
  3. Optic canal
  4. Optic chiasm
  5. Optic tract
  6. Visual cortex
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10
Q

Oculomotor Nerve

A
  • Cranial Nerve III
  • Innervates
    • Extrinsic eye muscles enabling most movements of the eye including rising eyelid
    • Intrinsic eye muscles enabling pupillary constriction and accommodation.
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11
Q

Oculomotor Nerve Pathway

A
  1. Midbrain of brainstem
  2. Red Nucleus
  3. Substancia Nigra
  4. Cavernous Sinus
  5. Superior Orbital Fissure
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12
Q

Trochlear Nerve

A
  1. Cranial Nerve IV
  2. Motor nerve to the superior oblique muscle of the eye (contralateral).
  3. The smallest cranial nerve.
  4. The only cranial nerve to exit the rear aspect of the brainstem.
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13
Q

Trochlear Nerve Pathway

A
  1. Dorsal aspect of midbrain
  2. Cavernous sinus
  3. Superior orbital fissure
  4. Orbit
  5. Superior oblique muscle
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14
Q

Trigeminal Nerve

A
  • Fifth Cranial Nerve (V)
  • Sensation in face
  • Motor of biting and chewing
  • Largest cranial nerve
  • Three sensory branches
    • Ophthalmic (V1)
    • Maxillary (V2)
    • Mandibular (V3)
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15
Q

Trigeminal Nerve Pathway

A
  1. Trigeminal Ganglion in Meckel’s Cave
  2. Pons
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16
Q

Trigeminal Ganglion

A
  1. Synapse of sensory nerves of Trigeminal Nerve
  2. Located in Meckel’s Cave
  3. Formed by three branches
    1. Ophthalmic nerve (afferent)
    2. Maxillary nerve (afferent)
    3. Mandibular nerve (mixed - joined by efferent component outside skull).
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17
Q

Ophthalmic Nerve

A
  • First division of Trigeminal Nerve (CN V)
  • Sensation for
    • eyeball
    • skin of upper face
    • anterior scalp
  • Smallest of trigeminal branches
  • Three branches
    • lacrimal
    • frontal
    • nasociliary
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18
Q

Ophthalmic Nerve Pathway

A
  1. Orbit
  2. Superior Orbital Fissure
  3. Lateral Cavernous Sinus
  4. Trigeminal Ganglion
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19
Q

Maxillary Nerve

A
  1. Second division of Trigeminal Nerve (CN V)
  2. Sensation of:
    1. Maxilla
    2. Nasal cavity
    3. Sinuses
    4. Palate
    5. Mid face
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20
Q

Maxillary Nerve Pathway

A
  1. Infraorbital foramen
  2. Inferior orbital fissure
  3. Pterygopalatine fossa
  4. Foramen rotundum
  5. Lateral Cavernous sinus
  6. Trigeminal Ganglion
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21
Q

Mandibular Nerve

A
  1. Third division of Trigeminal Nerve (CN V)
  2. Largest of Trigeminal branches
  3. Sensation of
    1. Inside of cheek
    2. Anterior 2/3 of tongue (not taste)
    3. Teeth of mandible
    4. Chin
    5. Lower lip
    6. Scalp
    7. Anterior ear
  4. Motor to muscles of mastication
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22
Q

Mandibular Nerve Pathway

A
  1. Afferent
    1. Foramen Ovale
    2. Trigeminal Ganglion
  2. Efferent
    1. Pons
    2. Under Trigeminal Ganglion
    3. Foramen Ovale
    4. Joins afferent nerves outside skull.
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23
Q

Abducens Nerve

A
  • 6th Cranial Nerve (VI)
  • Motor neuron to lateral rectus muscle responsible for outward gaze.
  • Nucleus in floor of 4th Ventricle in Pons, medial to Facial nerve.
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24
Q

Abducens Nerve Pathway

A
  1. Pons
  2. Junction of Pons and Medulla Oblongata
  3. Cavernous Sinus
  4. Superior Orbital Fissure
  5. Lateral Rectus muscle
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25
Q

Facial Nerve

A
  • 7th Cranial Nerve (VII)
  • Emerges from Pons
  • Afferent: taste for anterior 2/3rd of tongue
  • Efferent: muscles of facial expression
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26
Q

Facial Nerve Pathway

A
  • Pons
  • Internal Auditory Meatus
  • Facial Canal in Temporal bone
  • Stylomastoid Foramen
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27
Q

Vestibulocochlear Nerve

A
  • 8th Cranial Nerve (VIII)
  • Afferent: sound and equilibrium
  • Pons
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28
Q

Vestibulocochlear Nerve Pathway

A
  1. Internal Acoustic Meatus
  2. Pontomedullary junction
  3. Pons
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29
Q

Glossopharyngeal Nerve

A
  • 9th Cranial Nerve (IX)
  • Joins brainstem from sides of upper medulla oblongata
  • Exits skull via jugular foramen
  • Efferent:
    • Stylopharyngeal muscle
    • Parasympathetics to Parotid
  • Afferent:
    • Carotid sinus and body
    • tympanic membrane
    • Upper pharynx
    • Posterior 1/3 tongue: taste and sensation
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30
Q

Vagus Nerve

A
  • 10th Cranial Nerve (X)
  • Longest autonomic nerve in the body
  • Leave medulla between pyramid and cerebellar peduncle
  • Leaves skull via jugular foramen
  • Motor and sensory of viscera to colon
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31
Q

Accessory Nerve

A
  • 11th Cranial Nerve (XI)
  • Motor neuron to SCM and Trapezius
  • Neuron body in spinal cord
  • Enters skull via foramen magnum
  • Exits skull via jugular foramen
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32
Q

Hypoglossal Nerve

A
  • 12th Cranial Nerve (XII)
  • Motor neuron to all extrinsic and intrinsic muscles of tongue
    • except palatoglossus
  • Arises from small rootlets anterior medulla oblongata
  • Exits skull via hypoglossal canal
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33
Q

Optic Canal

A
  • Canal between orbit and middle cavity of skull in Sphenoid bone
  • Optic foramen is opening
  • Contains Optic Nerve (CN II) and Ophthalmic artery
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34
Q

Superior Orbital Fissure

A
  • Cleft between lesser and greater wings of sphenoid.
  • Contains:
    • Oculomotor Nerve (CN III)
    • Trochlear Nerve (CN IV)
    • 3 branches of Ophthalmic Nerve (CN V1)
      • lacrimal
      • frontal
      • nasociliary
    • Abducens Nerve (CN VI)
    • Ophthalmic Vein
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35
Q

Foramen Rotundem

A
  • Sphenoid bone
  • Connects middle cranial fossa with pterygopalatine fossa
  • Contains Maxillary Nerve (CN V2)
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36
Q

Foramen Ovale

A
  • posterior part of the sphenoid bone, posterolateral to the foramen rotundum in Greater Wing.
  • Middle cranial fossa
  • Contents
    • O: otic ganglion (inferior)
    • V: V3 cranial nerve (mandibular division of the trigeminal nerve)
    • A: accessory meningeal artery
    • L: lesser petrosal nerve
    • E: emissary veins
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37
Q

Stylomastoid Foramen

A
  • Temporal bone
  • Termination of Facial Canal
  • Transmits
    • Facial Nerve (CN VII)
    • Stylomastoid artery
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38
Q

Internal Auditory Canal / Meatus

A
  • Petrous portion of Temporal bone
  • Connects Posterior Cranial Fossa with inner ear
  • Contents
    • Facial Nerve (CN VII)
    • Vestibulocochlear Nerve (CN VIII)
    • Labyrinthine artery
    • Vestibular ganglion
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39
Q

Jugular Foramen

A
  • Petrous portion of temporal bone and occipital bone
  • Contents
    • Interior petrossal sinus
    • Sigmod sinus
    • Glossopharyngeal Nerve (CN IX)
    • Vagus Nerve (CN X)
    • Accessory Nerve (CN XI)
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40
Q

Hypoglossal Canal

A
  • Occipital bone
  • Medial and superior to occipital condyles
  • Transmits Hypoglossal Nerve (CN XII)
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41
Q

Foramen Magnum

A
  • Occipital Bone
  • Contents:
    • Anterior and Posterior spinal arteries
    • Vertebral arteries
    • Medulla Oblongata
    • Ascending fibers of Accessory Nerve (CN XI)
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42
Q

Cranial Nerves controlling eye movement

A
  • Oculomotor (CN III)
  • Trochlear (CN IV)
  • Abducens (CN VI)
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43
Q

Sections of the Brainstem

A
  1. Midbrain or mesencephalon
  2. Pons
  3. Medulla Oblongata
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44
Q

Midbrain Functions

A
  • vision
  • hearing
  • motor control
  • sleep/wake, arousal (alertness)
  • temperature regulation
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45
Q

Midbrain Regions

A
  • tectum (posterior)
  • cerebral aqueduct
  • tegmentum
  • cerebral peduncles.
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46
Q

Midbrain Location

A
  • Superior aspect of brainstem
  • Rostral: diencephalon
  • Caudal: Pons and Cerebellum
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47
Q

Occipital Ossification

A
  • Timeline
    • Begins at 6-12 weeks in utero
    • Begins unifying at 4 years old
    • Finishes unifying by 6 years old
    • Joins with sphenoid between 18 - 25 years old
  • 6 centers, all primary
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48
Q

Axis Primary Ossification Centers

A

5 Total

1 - centrum for body

2 - each half of neural arch

2 - dens

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49
Q

Axis Secondary Ossification Centers

A

2 Total

1 - tip of dens

1 - lower surface of body

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50
Q

Primary Ossification Centers for C3-L5

A

3 total

start at 9 weeks in utero

finish by one year

1 - centrum for body

2 - each half of neural ring

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51
Q

Secondary Ossification Centers of Vertebral Column

A

5 Total

Appear at puberty and finish by 25-30 years old

1 - tip of SP

2 - tip of TPs

2 - ring epiphyses at upper and lower body surfaces

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52
Q

Atlas Ossification

A

3 primary centers

No secondary centers

1 - Anterior arch (fuses by age 7)

2 - each side of posterior arch (fuses by age 3)

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53
Q

Axis Fusion Timeline

A
  1. Dens Primary centers fuse by 7th month in utero
  2. 2-3 yo: Neural arch fuses posteriorly
  3. 3-6 yo: Neural arch fuses to body and dens
  4. 3-6 yo: Dens fuses with body
  5. 3-6 yo: tip of dens appears
  6. 12 yo: tip of dens fuses with dens
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54
Q

Human skull has how many bones?

A
  1. 8 Cranial bones
  2. 14 Facial bones

Total 22 bones

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55
Q

What are the 8 cranial bones?

A
  1. Occipital bone
  2. 2 Temporal bones
  3. 2 Parietal bones
  4. Frontal bone
  5. Sphenoid bone
  6. Ethmoid bone
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56
Q

What are the 14 facial bones?

A
  1. 2 inferior nasal conchae
  2. 2 lacrimal bones
  3. 2 maxilla bones
  4. 2 nasal bones
  5. 2 palatine bones
  6. 2 zygomatic bones
  7. mandible
  8. vomer
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57
Q

Carotid Canal

A
  • Passageway in temporal bone from neck to middle cranial fossa.
  • Contains:
    • Internal Carotid Artery
    • Carotid Plexus of nerves
    • Sympathetics to head from Superior Cervical Ganglion
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58
Q

Foramen Spinosum

A
  • Greater wing of sphenoid connecting middle cranial fossa and neck.
  • Contains:
    • Middle meningeal artery
    • Middle meningeal vein
    • Meningeal branch of Mandibular Nerve (CN V3)
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59
Q

Spinomedullary Junction

A

Where the brainstem and spinal cord meet in the Foramen Magnum

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60
Q

What three muscles arise from the styloid process?

A

Stylohyoid

Stylopharyngeus

Styloglossus

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61
Q

What cranial nerves innervate the three muscles of the styloid process?

A

Stylohyoid - CN VII Facial

Stylopharyngeus - CN IX Glossopharyngeal

Styloglossus - CN XII Hypoglossal

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62
Q

Lambda

A

Convergence of

lambdoid and saggital

sutures

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63
Q

Bregma

A

Convergence of

coronal and sagittal

sutures

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64
Q

What ligament attaches to the basion?

A

Apical ligament

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65
Q

McRae’s Line

A

between basion and opisthion

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66
Q

Chamberlain’s Line

A

between hard palate and opisthion

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67
Q

McGregor’s Line

A

between hard palate and inferior most portion of occiput

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68
Q

Nasion

A

most anterior portion of frontonasal suture

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69
Q

Clinical significance of McRae’s Line

A

Normal position of the tip of the dens is 5mm below. Above this line it is a sign of basilar invagination.

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70
Q

Clinical significance of Chamberlain’s line

A

If tip of dens is greater than 3mm above it indicates basilar invagination

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71
Q

Clivoaxial Angle

A

Angle between posterior aspect of Clivus and posterior border of axial peg.

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72
Q

Clinical significance of Clivoaxial angle

A

Angle should be 150-180 degrees.

Less than 150 indicates possible compression of the contents of the foramen magnum.

Less than 130 associated with delay or failure to recover after foramen magnum decompression.

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73
Q

Normal neuroaxis behavior on CCJ flexion

A

The neuraxis stretches by about 10% of its total length on CCJ flexion.

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74
Q

Powers Ratio

A

Ratio of distance of two lines

Basion to C1 spinolaminar line (BC)

divided by

C1 anterior arch to Opistion (AO)

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75
Q

Clinical significance of Powers Ratio

A

If BC/AO is >1

indicates possible anterior atlanto-occipital dissociation

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76
Q

BaSN Angle

A

Cranial Base Angle

represents skull base curvature

  • normal: 125°-143°
  • platybasia: >143°
  • basilar kyphosis: <125°

The more obtuse this angle the more
retrognathic the mandible becomes.

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77
Q

Koenigsberg Modification

of

Cranial Base Angle

A

Line at base of anterior cranial fossa to tip of dorsum sellae

with clivus angle

Normal is 114 - 134

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78
Q

Grabb - Oaks Measurement

A

Line drawn from basion to posterior inferior C2 body

A perpendicular line drawn to dura

A value of 9mm or more indicates ventral brainstem compression.

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79
Q

Harris Lines

A

Basion Axial distance

and

Basion Dental interval

should both be less than 12mm

(Rule of 12s)

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80
Q

Significance of Harris Lines

A

distances of greater than 12mm is an indication of craniocervical instability.

Rule of 12s

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81
Q

Does dural venous drainage follow the arteries of the brain?

A

No, dural venous drainage does NOT follow the arteries of the brain.

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82
Q

To where to the veins of the brain drain?

A

The veins of the brain do not follow the arteries, but instead, drain into the dural sinuses, which subsequently drain into the internal jugular vein.

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83
Q

What are the dural sinuses made of?

A

Visceral periosteum and dural reflection lined with endothelium.

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84
Q

Which two dural sinuses are made differently than the others.

A

The Inferior Sagittal and Straight Sinuses both lack bony components as part of their wall.

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85
Q

What is “ag”

A

“ag” is arachnoid granulations

86
Q

What is “s”

A

”s” is a sagittal sinus pocket

87
Q

What is “SL”

A

“SL” is the sagittal sinus (superior)

88
Q

What is “VC”

A

“VC” is a draining cortical vein

91
Q

Torcula

A

Area of bone where confluence of sinuses is located

92
Q

Confluence of Sinuses

A

Where Straight Sinus and Transverse Sinuses join

93
Q

Superior Sagittal Sinus and Straight Sinus often become what?

A

Superior Sagittal Sinus often becomes the Right Transverse Sinus.

Straight Sinus often becomes the Left Transverse Sinus.

95
Q

Cavernous Sinus drains where?

A

Superior and Inferior Petrosal sinuses.

96
Q

Inferior Anastomotic Vein of Labbe

A

Drains the temporal lobe to the Transverse Sinus

97
Q

Superior Anastomotoic Vein of Trolard

A

Drains into Superior Sagittal Sinus

Largest Cortical Vein

98
Q

Internal Jugular Vein receive flow from what?

A

Inferior Petrosal Sinus

and

Sigmoid Sinus

99
Q

Deep Venous Sinuses

A

Drain into the Straight Sinus

  • Inferior Sagittal Sinus
  • Thalamostriate Veins
  • Internal Cerebral Veins
100
Q

Basilar Plexus

A

Connects the Inferior Petrosal Sinuses

Lies on the Clivus

102
Q

Veins of the Hypoglossal Canal

A
  1. Anterior Condylar Vein
  2. Lateral Condylar Vein
  3. Anterior Condylar Confluence
103
Q

Occipital Sinus Drainage

A

Drains from the

The confluence of Sinuses

to

Marginal Sinus

104
Q

Posterior Condylar Vein

A

Drains from the Sigmoid Sinus to the Suboccipital Cavernous Sinus via posterior condyloid canal

105
Q

Occipital Venous Drainage Diagram

106
Q

Veins of the Craniocervical Junction

A
  1. Sub-occipital Cavernous Sinus
  2. Marginal Sinus
  3. Internal Vertebral Venous Plexus
107
Q

Otic Ganglion

A

a small parasympathetic ganglion located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. It is functionally associated with the glossopharyngeal nerve and innervates the parotid gland for salivation.

108
Q

What are the four parasympathetic ganglia of the head and neck?

A

Otic Ganglion

Ciliary Ganglion

Submandibular Ganglion

Pterygopalating Ganglion

109
Q

The posterior arch of C1 fuses in most people by what age?

A

3 years old.

110
Q

Which primary ossification centers of C2 fuse first?

A

Odontoid centrally.

111
Q

The foramen ovale contains which branch of the trigeminal nerve?

A

V3: Mandibular

112
Q

How many bones are in the human skull?

113
Q

Which line is the modification to Chamberlain’s Line when the opisthion is obscured?

A

McGregor’s Line

114
Q

Which of the following would NOT be considered a major dural sinus?

  1. Superior Sagittal Sinus
  2. Petrosal Sinus
  3. Straight Sinus
  4. Transverse Sinus
  5. Sigmoid Sinus
A

Petrosal Sinus

115
Q

This sinus lies under the occipital bone surrounding the horizontal part of the vertebral artery.

  1. Basilar sinus
  2. Sub-occipital sinus
  3. Sigmoid sinus
  4. Marginal sinus
  5. Straight sinus
A
  1. Sub-occipital sinus
116
Q

The V3 section of the vertebral artery is best described by which statement?

  1. Passing through the transverse foramen of each cervical vertebra.
  2. Prior to reaching the transverse foramen of the cervical vertebra on each side.
  3. Between the atlanto-occipital membrane and where the artery finally enters the foramen magnum.
  4. The vertebral arteries turn posteriorly around the lateral masses of the atlas.
  5. Courses along the anterolateral surface of the medulla oblongata.
A
  1. The vertebral arteries turn posteriorly around the lateral masses of the atlas.
117
Q

Which of the following is NOT a contribution of the vertebral artery to the brain’s circulation?

  1. Posterior Inferior Cerebellar Artery
  2. Anterior Inferior Cerebellar Artery
  3. Superior Cerebellar Artery
  4. Posterior Cerebral Artery
  5. Anterior Choroidal Artery
A
  1. Anterior Choroidal Artery
118
Q

Typically the location of the basilar artery would be most proximal to which of the cranial nerves?

  1. I
  2. III
  3. V
  4. IX
  5. XII
119
Q

The cerebral aqueduct allows CSF to flow between which two spaces?

  1. Lateral ventricles
  2. Lateral and third ventricles
  3. 3rd and 4th Ventricles
  4. 4th Ventricle and meninges
  5. Arachnoid Villi and Superior Sagittal Sinus
A
  1. 3rd and 4th Ventricles
120
Q

Which of the following does NOT fit for the Rectus Capitus Posterior Major muscle?

  1. Origin: C1 Spinus
  2. Insertion: Occiput
  3. Innervation: C2
  4. Action: Extension and rotation
  5. all are correct
A
  1. Innervation: C2

The Rectus Capitus Posterior Major muscle is innervated, as are all four suboccipital muscles, by the suboccipital nerve (posterior ramus of C1).

121
Q

Which of the following are actions of the Levator Scapulae muscles?

  1. Lateral Flexion (spine)
  2. Rotation (scapula)
  3. Extension (spine)
  4. Elevation (scapula)
  5. 1, 2 & 4
A
  1. 1, 2, and 4

The Levator Scapula can laterally flex the spine or rotate and elevate the scapula.

123
Q

What is the relationship of the Internal Jugular and Internal Carotid just outside the skull?

A

The Internal Carotid is anterior and medial to the Internal Jugular just outside the skull.

124
Q

Where are the suboccipital muscles?

A

Under the occiput in the suboccipital compartment deep to the sternocleidomastoid, trapezius, splenius and semispinalis muscles.

125
Q

What is the collective action of the suboccipital muscles?

A

They collectively act to extend and rotate the head.

126
Q

What are the suboccipital muscles?

127
Q

By what are the suboccipital muscles innervated?

A

Suboccipital nerve, from the posterior ramus of C1.

128
Q

Two parts of the human brain’s arterial system.

A
  1. Internal Carotid
  2. Vertebral basilar
130
Q

Circle of Willis Internal Carotid Contributions:

A

Posterior communicating artery and rostral.

131
Q

Circle of Willis Vertebrobasilar contributions

A

Posterior Cerebral artery and inferior

132
Q

Circle of Willis Inferior Lateral

133
Q

Tongue taste and sensation

A

Post 1/3 taste and sensation : CN IX (glossopharyngeal)

Anterior 2/3 taste: CN VII (facial)

Anterior 2/3 sensation: CN V3 (mandibular)

134
Q

Innervation of the eye

A
  1. Optic (II): Sensation of light
  2. Oculomotor (III):
    1. Most extraocular muscles
    2. levator palpebrae superioris (upper lid)
    3. iris sphincter (PaSNS) pupillary constriction (miosis)
    4. ciliary muscle (PaSNS) contracture for accommodation.
  3. Trochlear (IV): superior oblique (down and in)
  4. Ophthalmic (V1):
    1. Sensory innervation
    2. afferent part of the corneal and lacrimation reflex
  5. Abducens (VI): lateral rectus (abduction)
  6. Facial (VII):
    1. Eye closure and blinking
    2. efferent part of the corneal and lacrimation reflex
  7. Long ciliary n. (superior cervical chain - SNS) pupillary dilation by contracture of iris dilator muscle

https://www.ncbi.nlm.nih.gov/books/NBK549919/#:~:text=Six%20cranial%20nerves%20innervate%20motor,facial%20nerve%20(CN%20VII).

136
Q
A

The cerebellar tonsil is part of the posterior lobe of the cerebellum, also known as the neocerebellum, which is responsible for coordinating the voluntary movement of the distal parts of limbs

137
Q
A

The flocculonodular lobe has important connections to the vestibular nuclei and uses information about head movement to influence eye movement. Lesions to this area can result in multiple deficits in visual tracking and oculomotor control (such as nystagmus and vertigo), integration of vestibular information for eye and head control, as well as control of axial muscles for balance. This lobe is also involved in the maintenance of balance equilibrium and muscle tone.

138
Q
A

the vermis is associated with bodily posture and locomotion. The vermis is included within the spinocerebellum and receives somatic sensory input from the head and proximal body parts via ascending spinal pathways

143
Q
A

The thalamus has several functions, such as the relaying of sensory signals, including motor signals to the cerebral cortex and the regulation of consciousness, sleep, and alertness.

144
Q
A

The fornix is a C-shaped bundle of nerve fibers in the brain that acts as the major output tract of the hippocampus. The fornix also carries some afferent fibers to the hippocampus from structures in the diencephalon and basal forebrain. The fornix is part of the limbic system.

145
Q
A

The corpos callosum spans part of the longitudinal fissure, connecting the left and right cerebral hemispheres, enabling communication between them. It is the largest white matter structure in the human brain

146
Q
A

the cingulate gyrus is highly influential in linking motivational outcomes to behavior (e.g. a certain action induced a positive emotional response, which results in learning). Part of the limbic system

147
Q
A

The telencephalon, commonly called the cerebral hemispheres, is the largest portion of the central nervous system (CNS) and consists of the cerebral cortex, subcortical white matter (commissural, association, and projection fibers), and basal nuclei.

150
Q
A

Atlanto-Axial Rotary Fixation

151
Q
A

Atlanto-Axial Rotary Fixation

152
Q
A

Atlanto-Axial Rotary Fixation

153
Q
A

Atlanto-Axial Rotary Fixation

154
Q

How many muscles typically attach to the Atlas?

155
Q

How many muscles typically attach to the axis?

166
Q

Superficial Neck Muscles

A

Clinical considerations

Larger lever arm

Greater capacity to exert torque

Local segmental instability if used in absence of deep muscle activation (Winters etal).

167
Q

Deep Neck Muscles (4th Layer)

A

Clinical Consideration

Contribute to fine control of head movement

Segmentally arranged

Shorter, stiffer (Toursel etal 2002)

Higher spindle density

More involved in postural support (due low-threshold, slow twitch characteristics) Boyd etal (2002)

168
Q

As neck extension progresses the moment arms in the SCM and Scalene Anticus reduce substantially causing a reliance on which 3 deep cervical flexors to resist extension?

A
  1. Longus Capitis,
  2. Longus Colli,
  3. Rectus Capitus Anterior
169
Q

Bilateral contraction of SCM causes which action:

a) in the upper cervical region?
b) in the lower cervical region?

A

a) Extension in the upper cervical region
b) Flexion in the lower cervical region

170
Q

Which 2 muscles are tasked with absorbing forces induced to the cervical spine during upper limb function and therefore may introduce compressive loading on cervical motion segments?

A
  1. Levator Scapulae
  2. Trapezius (upper)
174
Q

Relationship of V2 section of vertebral artery to cervical nerves.

177
Q

The mechanical properties of the AO joint and the AA joint are primarily determined by what?

A

The mechanical properties of the atlanto- occipital joint are primarily determined by bony structures, whereas those of the atlanto-axial joint are primarily determined by ligamentous structures.

178
Q

What is the predominant movements at the AO Joint?

A

The predominant movements at the atlanto-occipital joint are flexion and extension. Lateral flexion at the atlanto-occipital joint is significantly limited by the contralateral alar ligament.

179
Q

AA joint stabilization

A

The ligaments (transverse ligament and alar ligaments) related to this particular articulation which stabilise the joint complex. In the event of traumatic disruption of these ligaments, the atlanto-axial joints are poorly equipped to tolerate axial rotation.

180
Q

Alar Ligaments

A

attach the axis to the base of the skull and originate from the posterior surface of the upper third of the dens and typically travel caudocranially (in 50 % of cadeveric dissections) or horizontally (in 50 % of subjects).

Each ligament is narrowest at its origin and comparatively wider at its insertion giving it a “V-shaped” configuration

The alar ligaments limit axial rotation and lateral flexion on the contralateral side and, apart from the transverse ligament, are the strongest stabilisers of the atlas preventing anterior displacement in the event of rupture of the transverse ligament.

181
Q

Cruciform ligament (cruciate ligament)

A

The cruciform ligament is composed of transverse and vertical parts which form a cross behind the odontoid peg. The vertical component which is relatively weak and offers no discernible craniocervical stability consists of a cranially orientated longitudinal band which inserts on to the upper surface of the clivus between the

apical ligament and tectorial membrane and a caudally directed band which inserts on to the posterior surface of the body of the axis.

182
Q

Transverse Ligament

A

arguably the most important ligament in the body. It is the largest, thickest and, crucially, the strongest of the craniocervical junction ligaments (and, in fact, the strongest ligament in the entire spine) and, therefore, a primary stabiliser of the craniocervical junction.

The transverse ligament serves as the major stabiliser of the atlanto-axial articulation: it permits rotation at the atlanto-axial joints while, at the same time, the alar ligaments will prevent excessive rotation.

Tears of the transverse ligament typically occur laterally at the attachment to the tubercle on the atlas.

183
Q

Tectorial membrane

A

an upward extension of the posterior longitudinal ligament

184
Q

Apical ligament

A

This ligament extends from the tip of the odontoid process to the basion and is situated between the anterior atlanto-occipital membrane and the cruciform ligament

It may be absent in up to 20 % of subjects

185
Q

Anterior atlanto-occipital membrane

A

anterior aspect of the atlas to the anterior rim of the foramen magnum and is located immediately posterior to the prevertebral muscles

It serves to limit atlanto-occipital extension at the craniocervical junction.

186
Q

Posterior atlanto-ocipital membrane

A

believed to play very little part in stability of the atlantooccipital articulation

This broad ligament attaches the posterior arch of the atlas to the posterior margin of the foramen magnum and is continuous with the posterior atlantoaxial membrane and, subsequently, the ligamentum flavum

Interdigitations with both the dura mater and the related rectus capitis posterior minor muscle parenchyma may be present in this ligament; additionally, a connective tissue bridge (exhibiting increased vascularity) joining the rectus capitis posterior minor muscle to the spinal dura is frequently present, particularly in the midline. This myoligamentous complex (comprising the posterior atlanto-occipital membrane, interspinous ligament, ligamentum nuchae, rectus posterior major and minor muscles and obliquus capitis supripr and inferior muscles) adds further stability to the craniocervical junction

187
Q

Nuchal ligament (ligamentum nuchae)

A

This is a cephalic extension of the supraspinous ligament and extends from the spinous process of the C7 vertebra attaching to the inion of the occipital bone. A sturdy structure, it limits hyperflexion of the cervical spine

188
Q

Ossiculum terminale

A

The persistent ossiculum terminale results from failure of fusion of the secondary ossification centre (“terminal ossicle”) to the remainder of the odontoid process which has usually occurred by 12 years of age. It may be confused with a (type I) odontoid fracture. Identification of a smooth corticated margin is, again, central to discriminating the two aetiologies

189
Q

Os odontoideum

A

a separate ossicle with a smooth cortical border lying superior to a small hypoplastic dens and body of the axis in the location of the odontoid process

The anterior arch of the atlas may be rounded and hypertrophic in contrast to the normal anterior arch morphology. While the (type II) odontoid fracture is typically associated with a flattened uncorticated sharp margin to the adjacent body of the axis and normal morphology to the anterior arch of the atlas, the os odontoideum exhibits a well-corticated convex upper margin and rounded hypertrophic anterior atlas arch

190
Q

Calcification in the alar ligament

A

Rarely, nodular calcification/ossification can be seen in the alar ligament which can mimic type III fracture of the occipital condyle or type I fracture of the odontoid process

191
Q

traumatic alar ligament injuries

A

Traumatic alar ligament injuries typically occur near the condylar insertion. Alar ligament failure predisposes to excessive axial rotation with resultant compression of or dissection injury to the vertebral artery and damage to the spinal accessory nerves

192
Q

Atlanto-axial rotatory subluxation (AARS)

A

is relatively rare in the adult population, occurring more commonly in the paediatric population. In adults, the most common cause is trauma.

when the head is rotated normally, the neighbouring segments of the vertebral arteries are structurally affected: the ipsilateral vertebral artery will be kinked and the contralateral vertebral artery will be stretched.

Clinically, patients may demonstrate torticollis and adopt the cock-robin position of the head (because of the apparent descriptive resemblance of a robin listening for a worm in the ground) and occipital pain may occur as a result of compression of the greater occipital nerve or the C2 nerve root.

Patients may also experience vertigo, nausea, tinnitus and visual disturbances, possibly related to haemodynamic compromise of the vertebral artery.

Spasmodic torticollis (sternocleidomastoid muscle spasm) should be distinguished clinically from AARS—in the former, the shortened sternocleidomastoid on the side contralateral to the direction of head rotation is creating the force producing the deformity, whereas in the latter, the lengthened sternocleidomastoid muscle on the side ipsilateral to the direction of head rotation demonstrates spasm in an attempt to correct the deformity

198
Q

Dentate Ligaments

A

1) each DL is composed of a single narrow fibrous strip that extends from the craniovertebral junction to T12, and each also features 18-20 triangular extensions that attach to the dura at their apices;
(2) the triangular extensions are smaller and more numerous at the cervical levels, and are larger and less numerous at the thoracic levels;
(3) the apices of the extensions attach to the dura via fibrous bands at cervical levels (each band 3-5 mm long) and lower thoracic levels (21-26 mm long), whereas they attach directly to the dura at upper thoracic levels;
(4) the narrow fibrous strip of the DL features longitudinally oriented collagen fibers, whereas the triangular extensions are composed of transverse and obliquely oriented collagen fibers. The collagen fibers are thicker and more abundant at the cervical than at the thoracic levels.
(5) The first (superiormost) pair inserts into the lateral borders of the foramen magnum, with the vertebral artery anterior to them and the hypoglossal nerve (CN XII) posterior. The inferiormost pair is at the level of the conus medullaris, namely, between the T12 and L1 segmental nerve roots, and its pia mater fuses with the filum terminale.
(6) Each triangular ligament has a vertically oriented base that emanates from the spinal cord between the exit point of the ventral root and entry point of the dorsal root, and an apex which points laterally and attaches to the dura mater just posterosuperior to the neural foramen

https://pubmed.ncbi.nlm.nih.gov/22555553/

https://radiopaedia.org/articles/denticulate-ligaments?lang=us

199
Q

Dorsal Meningovertebral Ligaments

A

The dorsal meningovertebral ligaments in the cervical region anchored the posterior dural sac to the ligamentum flavum or laminae.

the occurrence rate of dorsal meningovertebral ligaments was 100% at C1-C2 and C4–C5.

The thickest ligaments were observed at the C1 and C2 vertebrae.

the orientation of the ligaments mostly was craniocaudal.

At C1 & C2 the Dorsal Meningovertebral Ligaments become thicker and become known as Myodural bridges”

Case courtesy of Dr Matt Skalski, Radiopaedia.org, rID: 65838

200
Q

Myodural Bridges

A

Anatomical soft tissue bridges which cross the cervical epidural space, connecting suboccipital muscle fascia and dura have passive and active functions to anchor the spinal cord.

These myodural bridges may be involved in a dural tension monitoring system to prevent dural infolding and maintain patency of the spinal cord.

Failure of this system could result in altered cerebral spinal fluid flow, changes in sensorimotor function, cervicocephalic headaches, and dural related pathologies.

the Superior Myodural bridge connects the RCPMi fascia to the dura via the Occipito-atlantal interspace.

The Inferior Myodural bridge connects the fascia of the RCPMa and OCI to the dura via the Atlanto-axial interspace.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025088/pdf/jcca_v58_2j_p184-enix.pdf

201
Q

CSF Volume

A

total CSF volume in the adult is approximately 130 ml

of which about 60 ml is contained within the cranial cavity

and about 70 ml is stored within the vertebral canal.

202
Q

Intervertebral disk nutrition and innervation

A

Nutrition: The intervertebral discs, like other cartilages, have no blood supply. (outer 1/3?). They form the largest structures in the body without their own blood vessels. The nutrients they require are absorbed from circulating blood by means of osmosis.

Innervation: The intervertebral disc is innervated through the sinovertebral nerves. The nerve fibres are mainly restricted to the outer lamellae in the endplate. Most of those sinovertebral nerves are meningeal branches of spinal nerves.

203
Q

Dura Mater Innervation

A

CN V

CN X

C1-3

204
Q

CSF Flow influencers

A

Cardiac

Respiration

Vasomotor (autonomic)

205
Q

Monro-Kellie Doctorine

A

The brain, blood and CSF are the space-occupying components of the cranium and they must co-exist in a state of dynamic equilibrium.

A change in volume in one component requires a change in volume in either or both of the other two.

Systole (brainstem and CSF move caudally)

Diastole (brainstem and CSF move cephalad)

206
Q

Traube-Herring Mayer (THM) (Vasomotor) waves

A
  • generated by spontaneous pulsations of arterial, venous and lymphatic vessels.
  • independent of the respiratory and cardiac cycles
  • generally longer wavelengths than those of the respiratory and cardiac
  • mediated by the autonomic nervous system and
  • along with increased heart rate variability, are considered to be markers of good autonomic balance.
207
Q

C waves

A
  • intracranial arteries cause the propagation of waves of elevated intracranial pressure
  • first described Lundberg described C waves as rhythmic oscillations with a frequency of 4–8 per minute (most frequently 6 per minute) and an amplitude of up to 20 mm Hg.
  • Because of the close association between C waves and Traube-Herring Mayer waves, any effect of C waves is probably a healthy one”
208
Q

Red Nucleus

A
  • Located in midbrain
  • Lesion affect is contralateral
  • Plays an important role in locomotion and several theories suggest that it has evolved dramatically with the advent of bipedalism.
209
Q

Reticular formation

A

The reticular formation is made up of a net-like structure of various brainstem nuclei and neurons and covers an expansive portion of the brainstem, beginning in the mesencephalon, extending caudally through the medulla oblongata, and projecting into the superior cervical spinal cord segments.

Due to the expansive network of tracts and the interconnected structure, the reticular formation functions as an integration, relay, and coordination center for many vital life functions and controls many of the protective reflexes.

Regulator of arousal and consciousness

Modifies reflex activity and muscle tone

Modulates somatic and visceral sensation (regulation of pain perception)

Coordinates respiratory centres that control the muscles of respiration

Works with vestibular apparatus to preserve muscle tone in antigravity muscles

Present bilaterally able to provide motor control to both sides of the brain when a person laughs or smiles

210
Q

Semicircular Canals (motion detection)

A
  • Anterior/Superior semicircular canal is situated perpendicular to the temporal bone and detects motion in the sagittal plane - nodding
  • Lateral/Transverse semicircular canal (smallest & horizontal) detects rotation of the head in the transverse plane - no
  • Posterior semicircular canal detects rotation in the coronal/frontal plane – tilting
  • Note: Superior Semicircular Canal Dehiscence - the only canal not fully enclosed by bone but by dura at it’s superior most reach (if this herniates creates a third window to exchange CSF)
211
Q

Cervical Spondylotic Myelopathy

A

Impaired function of the spinal cord caused by degenerative changes of the discs and facet joints in the cervical spine compressing the cord.

Common Symptoms: neck stiffness, arm pain, clumsy or weak hands, numbness in the hands, and weakness of the hands and legs, unsteady gait, hesitancy on urination

DDx: multiple sclerosis, amyotrophic lateral sclerosis and masses (such as metastatic tumors) that press on the spinal cord

Common signs: atrophy of the hand musculature, , sensory loss hyperreflexia, Lhermitte’s sign (electric shock-like sensation down the center of the back following flexion of the neck)

Hoffman Sign: a reflex contraction of the thumb and index finger after nipping the middle finger

212
Q

Upper Cervical Myotomes

A

C1 Upper Cervical Flexion

C2 Upper Cervical Extension

C3 Cervical Lateral Flexion

C4 Shoulder Girdle Elevation

C5 Shoulder Abduction

C6 Elbow Flexion

C7 Elbow Extension

C8 Thumb Extension

T1 Finger Adduction

DCCJP (7 decks)

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