Midterm 1 Flashcards
Where is the pain sensitivity within the skull restricted to
Pain sensitivity in the skull is restricted tot he intracranial meninges
What are the three layers of the Meninges
Dura mater
Arachnoid mater
Pia Mater
Describe the dura mater
Thickest, outermost layer, protective, impermeable
Made of two layers: Periosteal layer, Meningeal layer
Describe the two layers of the Dura mater
Periosteal: attached to inner surface of skull, continuous with periosteum (outside) on outside of skull bones and cranial sutures
Meningeal layer: covering brain, penetrates spaces in cerebral hemispheres
Describe the arachnoid mater
Middle layer, impermeable, adjoins dura (not tightly bound- potential subdural space) separated from Pia by Subarachnoid space that is filled with CSF
Describe the Pia mater
Delicate, permeable, innermost, resting on the brain surface
vascular membrane that adheres closely to brain
What are the two important partitions that arise from the meningeal layer
Falx cerebri, tentorium cerebelli
Describe the Falx cerebri
Sickle-shaped fold separating the cerebral hemispheres. The superior convex border forms floor of superior sagittal sinus; inferior border houses inferior sagittal sinus
Restrict brain displacement
Tentorium cerebelli
Fits between the cerebellum and the occipital lobes; separates the posterior cranial fossa from the rest of the cranial vault. Arches upward along median line to become continuous with falx cerebri to form straight venous sinus
Restrict Brain displacement
What is the location, usual cause, and symptoms of an epidural hemorrhage
Location: tight potential space between the dura and the skull
Cause: rupture of the middle meningeal artery during head trauma
Symptoms: initially no symptoms (lucid interval), within hours the hematoma compresses the brain and increases ICP, which leads to herniation and death. (unless surgery)
What is the location, usual cause, and symptoms of an subdural hemorrhage
Location: potential space between the dura and the loosely adherent arachnoid
Cause: rupture of bridging veins that pass through en route to dural sinuses (vulnerable to shear injury)
Same symptoms has epidural
What are acute and chronic subdural hematomas/hemorrhages
Acute: can occur with high velocity impact
Chronic: seen in elderly where brain atrophy allows the brain to move freely (bridging veins susceptible to injury). Slow bleeding over weeks/ months allows brain to accommodate so symptoms often vague: headache, cognitive impairment, unsteady gait.
What is the time frame each blood is seen in the brain: hyperdense, isodense, hypodense
hyperdense: More dense than surrounding brain tissue, acute/ recent injury
Isodense: 1-2 weeks
Hypodense: 3-4 weeks
What separates the Pia from the Arachnoid mater
Subarachnoid space (CSF)
Where are all cerebral arteries and veins (aneurysm site, may hemorrhage)
subarachnoid space, sending off branches that penetrate into the brain
How is the Arachnoid connected to the Pia
Delicate threads called trabeculae
What are arachnoid granulations
site where CSF diffuses into the venous sinuses
What layer fuses with the ependyma to form the choroid plexus
Pia mater, arteries carry sheath of pia as they enter the parenchyma
Where does pain from headaches come from
No pain receptors in brain, so pain comes from trigeminal and first three cervical nerves innervating the meninges and vasculature
Dura above the tentorium by the trigeminal ganglion
Dura below the tentorium by cervical nerves
What innervates the dura above and below the tentorium
Above: trigeminal ganglion
below: cervical nerves (1-3)
What do migraines depend on
depend on the activation of the trigeminal afferents that densely innervate the meninges
Meningitis and meningiomas
Inflammation of the meninges and tumors in the meninges
Effects of space-occupying lesions
Increased ICP and stretching of dura
What is a cluster headache
Lancinating or boring periorbital pain. More sever than childbirth
How does a hangover affect the meninges
toxic effect on meninges
Where do immune cells reside? how does inflammation affect immune cells?
Meningeal spaces
Inflammation = activation of immune cells. When immune cells are activated, they release things that lower the threshold of activation of pain fibres
Which arteries are responsible for posterior and anterior circulation
Anterior: internal carotid artery
Posterior: vertebral artery
Which arteries supply each cerebral hemisphere
carotid and vertebral arteries supply each cerebral hemisphere
What is the Circle of Willis? What is anastomosis
Anterior and posterior blood supply combines at the circle of Willis. Circle of WIllis provides overlapping blood supply and alternative routes for blood flow.
Anastomosis (circulatory connection between 2 blood vessels) protects the brain when part of vascular supply is blocked
Which cerebral arteries are important for anterior circulation and posterior circulation
Anterior: middle cerebral artery, anterior cerebral artery
Posterior: Posterior cerebral arteries
which cortical area does the MCA supply
most of the lateral convexity of the cortex (except the leg area of motor homunculus) and white matter, including the frontal, parietal, temporal, and occipital lobes of the insula
which cortical area does the ACA supply
The cortex and white matter of the medial frontal and parietal lobes and the anterior corpus callosum
A strip of cortex (1inch) wide on later surface
which cortical area does the PCA supply
The occipital lobes and portions of the medial and inferior temporal lobes and the posterior corpus callosum
How do deep structures receive blood
Deep structures receive blood directly from branches of the internal carotid artery and proximal portions of the cerebral arteries
what is the most common site of infarction/ ischemia
MCA
How does gray matter of the cerebral cortex and underlying white matter receive blood
supplied by branches of more distal cerebral arteries
What does in infarction in the MCA result in
Contralateral Hemiparesis and hemisensory loss (mainly in face and arm)
What is hemineglect? How does it happen?
Unawareness of space and the patient’s own body contralateral to the lesion. Patients may seem unaware or deny the handicap. This may include unawareness of quite dramatic impairments such as blindness or paralysis. May not take care of the contralateral side of the body, deny own limbs, ignore objects in the contralateral visual field
Happens by an infarct in the right hemisphere MCA
Patients may experience anosognosia (denying or unaware of their handicap)
What is parietal neglect syndrome
- Failure to recognize side of body contralateral to injury
- May not bathe contralateral side of body or shave contralateral side of face
- Deny own limbs
- Objects in contralateral visual field ignored
What is Aphasia? What is the cause
Inability to comprehend or formulate language
Caused by infarct in left hemisphere MCA
What is Broca’s aphasia
Difficulty producing speech, comprehension intact
What is Wernicke’s aphasia
difficulty comprehending speech, speech fluent, well structured, grammar and syntax adequate by nonsensical.
What does an infarct in the ACA result in
Contralateral hemiparesis: paralysis or weakness of one side of the body
Hemisensory loss involving mainly the leg and foot
Personality changes (frontal lobe)
What does an infarct in the occipital region of the PCA result in
Hemianopsia or visual agnosia
What is hemianopsia
Loss of vision for one half of the visual field
What is visual agnosia
Inability to recognize or interpret objects in the visual field
What does an infarct in the temporal region of the PCA result in
memory impairment
What is prosopagnosia? What part of the cortex is damaged? what is the most common cause
Inability to identify facial characteristics or not able to recognize a face at all. Damage to the inferior temporal cortex. Most common cause is a PCA stroke
What is a stroke
death or dysfunction of brain tissue due to vascular disease
What is an infarction
neuronal death
What is ischemia
insufficiency of blood supply
what is anoxia
reduced oxygen supply
what is an embolus
Material carried from one point to lodge in another
(blood clot, air, or fat forms somewhere and travels to lodge somewhere else)
What is an embolism
Embolus becomes lodged in an artery and obstructs flow
describe hemorrhagic. what does it lead to
bleeding from a vessel (high chance if you have hypertension or aneurysm)
Describe occlusive and what does it lead to
Closure of a vessel
(high chance if you have Atherosclerosis or thrombosis
What is tissue plasminogen activator (tPA)
A protease enzyme that catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown
What does intraparenchymal hemorrhage mean
within the brain
What does extraparenchymal hemorrhage mean
at the brain surface
What is an intracranial aneurysm
Weakness in the wall of a cerebral vasculature causes a localized dilation or ballooning of the blood vessel
How could you fix a cerebral aneurysm
endovascular coiling or surgical clipping
What is endovascular coiling
A catheter is inserted in the artery and guided to the aneurysm, a stent is released to prevent the coil from blocking flow, the catheter is guided to the aneurysm to be filled with coil, the coil fills the aneurysm to prevent further growth and rupture
What is surgical clipping?
Using a clip on the base of an aneurysm, preventing blood flow into the aneurysm
(very invasive, requires craniotomy)
Where do superficial veins, deep veins, and the superior sagittal sinus drain into
Superficial –> Super sagittal sinus and cavernous sinus
Deep –> Great vein of Galen
Superior sagittal sinus –> 2 transverse sinuses –> sigmoid sinus –> jugular vein
Venous blood drains into a system of valve channels called dural venous sinuses
Homeostasis of the the three fluid compartments are regulated by what?
Blood-brain and blood-CSF barriers
Describe the vasculature of the arachnoid mater
- The arachnoid mater is an epithelial layer that provides a barrier between the peripheral vasculature of the dura mater and the CSF present in the subarachnoid space through tight junctions and efflux pumps
Describe the vasculature of the dura matter
- The dura mater contains lymphatics and fenestrated blood vessels that lack tight junctions.
Describe the vasculature of the pia mater
- The pia mater meningeal blood vessels lack astrocytic ensheathment, but their endothelial cells are connected by tight junctions.
- The Pial arteries penetrating the brain are covered by a densely packed perivascular layer of astrocytic foot processes; Veins exiting the parenchyma have a perivascular space flanked by astrocytic foot processes as well as endothelial basement membranes (BMs). The pial BM is only present in the superficial (brain surface) portion of the veins.
What are the three intracranial fluid compartments
CSF compartment, interstitial compartment of the brain, intracellular compartment of the brain
What is the choroid plexus
Specialized capillary networks that secrete CSF