Meninges brain and spine

Question 1

Name the two layers of the dural matter

Answer 1

Periosteal layer

Meningeal layer

Question 2

1. Vascularisation of the dura matter?

2. Innervation of the dura matter?

Answer 2

1. Middle meningeal artery and vein

2. Trigeminal nerve V1, V2, V3

Question 3

Does the dura have BBB?

Answer 3

No the dura lacks BBB

Question 4

Name the dural reflections

Answer 4

Falx cerebri
Tentorium cerebelli
Falx cerebelli
Diaphragma sella

Question 5

What is the tentorial notch?

Answer 5

Opening in the anterior part of the tentorium cerebelli for the passage of the midbrain . Also called tentorial notch

Question 6

What are the dural venous sinuses?

Answer 6

Venous channels located between the two layers of the dura matter

Question 7

Innervation and vascularisation of the arachnoid and pia matter?

Answer 7

Arachnoid: Avascular, no innervation

Pia matter: Highly vascularised

Question 8

Layers of pia matter

Answer 8

Epipial layer

Intima pia

Question 9

What is a perivascular space ?

Answer 9

Space between the vessel wall and the pia

Question 10

Name the layers of the spinal meninges?

Answer 10

Dura, Arachnoid, Pia matter

Question 11

Which layer of the cranial dura mater continues in the spine?

Answer 11

The meningeal layer

The endosteal layer stops at the foramen Magnum

Question 12

Describe the spinal spaces

Answer 12

The Epidural Space (true space) between dura and periosteum (contains Fat, Internal venous plexus, spinal roots below S2)
The subdural space (virtual space) between arachnoid and pia (contains arachnoid trabeculae, CSF, Vessels)

Question 13

Where are usually (if ever) subdural haematomas in the spine?

Answer 13

Ventrally (while epidural ventral or dorsally)

Question 14

What is the origin of the arachnoid and pia matter?

Dura matter?

Answer 14

Arachnoid + Pia = Ectoderm

Dura: Mesoderm

Question 15

What is the origin of all meninges?

Answer 15

Perimedullary mesenchyme

Question 16

Describe the patterns of dural enhancement

Answer 16

a. Pachymeningeal = Dura and arachnoid

b. Pia-subarachnoid = Leptomeningeal enhancement

Question 17

Pachymeningeal enhancement differential

Answer 17

Intracranial hypotension
Post-operative changes
Granulomatous disease
Meningioma
Metastasis
Lymphoma

Question 18

Pia-Subarachnoid enhancement differential

Answer 18

Meningitis (bacterial, viral, fungal)

Carcinomatous meningitis

Question 19

Thick lumpy nodular enhancement

Bilateral thin - linear enhancement suggests

Answer 19

Carcinomatosous meningitis

Infectious meningits

Question 20

Unilateral thin - linear enhancement suggests

Answer 20

IgG pachymeningitis
Sturge-Weber
Neurosarcoidosis
Vasculitis

Question 21

What is the best sequence for meningitis?

New sequece?

Answer 21

CE FLAIR

CE 3D T1 TSE black blood

Question 22

Imaging findings of meningitis?

Answer 22

High FLAIR CSF spaces
Dural/meningeal enhancement
Hydrocephalus
Subdural effusions/empyema
Infarcts
Restricted diffusion VR spaces

Question 23

Findings of neurosarcoid?

Answer 23

Solitary or multifocal masses
Dural (30-50%) meningeal (30%) 
Optic chiasm, hypothalamus, infudibulum
Cranial nerves
Spine