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Head And Neck > Meninges And Dural Venous Sinuses > Flashcards

Meninges And Dural Venous Sinuses Flashcards

1
Q

What are the meninges?

A

3 membranous layers surrounding the brain and spinal cord

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2
Q

What are the 3 layers of the meninges (Innermost to outermost)

A
  • Pia Mater: Firmly attached to surface of brain
  • Arachnoid Mater: Delicate avascular middle layer
  • Dura Mater: Tough outer layer, made up of 2 layers
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3
Q

What are the bumps and dips of the brain called? Which meningeal layer follows these contours?

A

Bumps- Gyri
Dips- Sulci

Pia Mater

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4
Q

Describe the arachnoid mater’s relationship to Pia Mater

A
  • Superficial to Pia Mater

- Trabeculae extend downward from its inner surface and become continuous with Pia Mater

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5
Q

What is the region between the Arachnoid and Pia mater?

What is it full of?

A

Sub-arachnoid space

Full of CSF, veinous and arterial blood vessels

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6
Q

What does the term Leptomeninges mean?

A

Combined term for Pia and Arachnoid mater

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7
Q

The Dura Mater consists of 2 layers.

Compare them

A

Outer Periosteal;

  • Firmly attached to skull
  • Contains meningeal arteries
  • Continuous with periosteum on outer surface of skull
  • Not continuous with spinal dura matter through Foramen magnum

Inner Meningeal;
- Continuous with spinal dura mater through foramen magnum

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8
Q

Describe the relationship between the Inner Dural layer and Arachnoid Mater

What is the clinical significance of this?

A

Arachnoid Mater pushed up against Inner Meningeal Layer by CSF

Forms the Subdural space (a potential space)

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9
Q

What does the Arachnoid Mater look like

A

Translucent

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10
Q

What are 2 types of locations where the 2 layers of the dura mater separate from each other?

A
  • Dural venous sinuses (blood between 2 layers)

- Dural partitions/ folds, which project inwards and incompletely separate parts of brain

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11
Q

What is the Extradural space?

A

A potential space between dura mater and bone

Can fill with blood from a meningeal artery rupture or torn Dural venous sinus

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12
Q

Name 4 Dural Folds

A
  • Falx Cerebri (Vertical)
  • Tentorum Cerebelli (Horizontal)
  • Falx Cerebelli
  • Diaphrgam Sellae
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13
Q

What is the Falx Cerebri?

A
  • A crescent shaped downward projection of meningeal dura mater, that separates the left and right hemisphere
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14
Q

Name the attachments of the Falx Cerebri

A

Anterior: Crista Galli of ethmoid bone (and frontal crest of frontal bone)

Posterior: Blends with Tentorum Cerebelli

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15
Q

What is the Tentorum Cerebelli?

A
  • A horizontal projection of meningeal dura mater, that separates the Cerebellum from the posterior parts of the cerebral hemispheres
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16
Q

What are the attachments of the Tentorum Cerebelli?

A

Posteriorly: Occipital bone along grooves of Transverse Sinuses

Laterally: Superior border of Petrous part of Temporal bone

17
Q

Describe the Anterior and Medial borders of Tentorum Cerebelli

A

Are free, forming an oval opening in the midline (The Tentorial Notch), through which midbrain passes

18
Q

What do the Dural Folds do? (In general)

A
  • Help to stabilise brain and act as rigid dividers
19
Q

Considering the Dural Folds, what can happen when intra-cranial pressure rises?

(Such as due to a bleed)

A

Can lead to compression/ herniation of parts of brain against the Dural Folds or Through Foramen Magnum

(Can lead to mental consequences)

20
Q

What connects the back of the Inferior Saggital Sinus to the Superior Saggital Sinus before it branches off into Transverse sinuses?

A

Straight Sinuses

21
Q

What is the Inferior Petrosal Sinus?

A

Connects posterior Cavernous Sinus to Sigmoid Sinus, just before SS leaves skull base

22
Q

What is the Superior Petrosal Sinus?

A

Connection between posterior Cavernous Sinus and Transverse Sinus, just before TS becomes Sigmoid Sinus

23
Q

What are Bridging and Emissary Veins

A

Bridging: Connect Dural Veinous Sinuses to Cerebral Veins

Emissary: Connect Dural Veinous Sinuses to Scalp Veins (This is how scale infections can enter skull)

24
Q

What are the 3 spaces between the meningeal layers where blood can accumulate

Where else can bleeding occur?
How?

A
  • Extradural (Bone and Dura)
  • Subdural (Dura and Arachnoid)
  • Subarachnoid (Arachnoid and Pia)
  • Within the brain tissue itself (Intra-cerebral haemorrhage)
  • Contusions, tearing of white matter etc.
25
Q

What can increased intracranial pressure due to haemorrhage cause?

A
  • Brain tissue damage/ compression
  • Brainstem displacement/ damage
  • Cranial nerve compression/ damage/ irritation
26
Q

Which artery runs between Periosteal Dura and Inner Table of bone?

Why is its anterior branch particularly susceptible to damage/ rupture in trauma?

A

Middle Meningeal Artery

Runs underneath Pterion (Thinnest part of calvaria)

27
Q

How does Extradural haemorrhage affect Periosteal dura mater?

A

Causes it to tear off of Periosteum

28
Q

How does an Extradural Haemorrhage present on a CT scan?

Why is it this colour?

A
  • Bright white lentiform/ Biconvex shape
  • Fresh blood looks bright white on CT

(Shape is because lateral filling of blood is limited)

29
Q

How does an Extradural Haemorrhage patient usually present?

A
  • Significant head trauma-> Loss of consciousness
  • Appear normal when they come around
  • Significant rapid neurological deterioration after a brief period (an hour or so)
30
Q

What is a Lucid Interval? (Occurs in Extradural haemorrhage)

A

Period between loss of consciousness and rapid neurological deterioration, where patient seems normal

31
Q

What type of blood usually causes a Subdural Haemorrhage?

A

Veinous blood from Bridging Vein

32
Q

Subdural haemorrhages can happen via significant trauma OR minor head injury, particularly in older patients.

Why is this?

A

As we age our brain shrinks slightly, putting more tension on the Bridging Veins, increasing the risk of them rupturing/ tearing/ being damaged

33
Q

How does a Subdural haemorrhage appear on a CT?

Why does it have this shape?

A
  • Bright white, crescent shape

- The bleed can fill subdural space of entire hemisphere on which it occurs

34
Q

How does a Subdural Haemorrhage patient present?

A
  • Initially normal, may have headache

- Gradually deterioration of Neurological condition (As it is a Veinous bleed not arterial bleed)

35
Q

What important arteries are in the Subarchnoid Space?

A

Cerebral arteries, forming the Circle of Willis

Usually an arterial bleed

36
Q

What are 2 causes of Subarachnoid Haemorrhage?

A
  • Usually due to trauma

- Spontaneous blood vessel rupture (Aneurysms, can form at Circle of Willis)

37
Q

In a Subarachnoid Haemorrhage, why do we get sudden, severe headaches?

Why can we use a Lumbar Puncture to diagnose this?

A
  • Blood is highly irritant to meninges, therefore headache

- Blood enters subarachnoid space and mixes with CSF

38
Q

Subarachnoid haemorrhages are often fatal.

What are the chances of survival if picked up by CT within 24 hours?

What about within 6 hours?

What if CT is inconclusive?

A
  • <24hrs: 93%
  • <6hrs: 100%

Do a Lumbar puncture and look for Hb degradation products

39
Q

How does a Subarachnoid Haemorrhage appear on a CT?

A
  • Bright white shape around base of brain, where aneurysms are known to occur (Circle of Willis)

Head And Neck (20 decks)

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