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MRCS Part B > Neuroanatomy > Flashcards

Neuroanatomy Flashcards

1
Q

Skull Vault

1-9

A

1. Anterior Fossa 2. Middle Fossa 3. Posterior Fossa

4. Frontal Crest. 5. FOramen Caecum

6. Crista Galli 7. Cribiform plate

8. Optic Canal 9. Anterior Clinoid Process

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2
Q

Skull vault

10 -24

A

10. Sup. Orb. Fissure 11. Foramen Rot.

12. Foramen Oval. 13. Foramen Spin.

14. Foramen Lac. 15. Int. Acc. Meat.

16. Jug. Foramen 17. For. Magnum

18. Hypoglossal Canal 19. tegmen Typamni

20. Pit. Fossa 21. Dorsal Sellae

22. Clivus 23. Sphenoid lesser wing

24. Sphenoid greater wing

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3
Q

Skull Vault

Grooves 25-29

A

*Groove for*

25. middle meningeal artery

26. Sigmoid Sinus

27. Superior petrosal sinus

28. Transverse sinus

29. Sup. Saggital Sinus

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4
Q

Layers of the SCALP

A

Skin

Connective Tissue

Aponeurosis

Loose Areolar tissue

Periosteum

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5
Q

Bones of the cranial cavity

1) Name them

2) What is the pterion

A

1) Frontal, Temporal, Parietal, Occipital, Sphenoid, Ethmoid

2) Pterion is a thin portion of skull at the junction of frontal, temporal, parietal + greater wing of sphenoid.

Anterior branch of middle meningeal artery runs beneat it

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6
Q

Structures running through:

i) Optic Canal

ii) Superior Orbital Fissure

iii) Spinosum

iv) Internal Accoustic Meatus

v) Jugular Foramen

A

i) Optic Nerves + Ophthalmic Artery
ii) CN III, IV, Va, VI. Ophthalmic Vein
iii) Middle meningeal artery, meningeal branch of mandibular nerve
iv) Facial nerve. travels through facial canal (forms geniculate ganglion) and then exits through stylomastoid foramen
v) IJV, CN IX, X, XI, Inferior petrosal sinus

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7
Q

Boundaries of bony orbit:

A

Roof:

Frontal Bone (ant.) Great wing sphenoid (post.)

Floor:

Zygoma (lat.) Maxilla (medial.)

Medial Wall:

Maxilla (frontal process), Frontal, Lacrimal,

Ethmoid (orbital plate), Sphenoid
Lateral Wall:

Zygoma (frontal process), Frontal (zygoma process)

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8
Q

The Orbit

Label 1-10

A

1. Squam. temp. bone. 2. Zygomatic Bone

3. Sphenoid Greater wing

4. Sphenoid lesser wing 5. Nasal Bone

6. Maxilla (Frontal process)

7. Frontal Bone (orbital part)

8. Inferior orbital Fissure

9. Superior Orbital Fissure 10. Optic Canal

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9
Q

The orbit

Label 11-20

A

11. Infra-orbital groove

12. Infra-orbital foramen

13. Posterior ethmoid foramen

14. Supra orbital foramen 15. Glabella 16. Naison

17. nasal septum 18. Conchae

19. Frontozygomatic suture 20. pterion

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10
Q

The Orbit 2

1-8

A

1. Parietal Bone 2. Frontal Bone

3. Sphenoid Greater Wing

4. Squamous temporal bone. 5. ethmoid bone

6. Lacrimal bone 7. maxilla 8. Zygomatic Bone

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11
Q

The Orbit 2

9-15

A

9. ant. ethmoid foramen

10. ant. + post. ethmoid crests 11. Lacrimal fossa

12. Nasolacrimal canal

13. Zygomaticofacial foramen

14. Frontozygomatic suture

15. Pterion

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12
Q

Ocular Muscles

i) Nerves + which muscles they innervate + action

A

Occulomotor Nerve (III) - Nucleus in Pons-Midbrain junction

  • Superior Rectus (Upward Gaze)
  • Middle Rectus (Medial Gaze)
  • Inferior Rectus (Downward Gaze)
  • Inferior Oblique (Upward Gaze)
  • Levator palpebrae superioris (raises eye lid)
  • Ciliary Muscles (lens adjustments)
  • Constrictor Pupillae (Parasympathetic fibers)

Trochlear Nerve (IV) - Nucleus in pons

Superior Oblique (downward gaze)

Abducens Nerve (VI) - nucleus in medulla oblongata

Lateral Rectus (lateral gaze)

Nasociliary N (V1) - Sympathetic fibers

Dilator Pupillae

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13
Q

3rd Nerve Palsy

A

Down and out pupil - Lateral rectus (lateral) + Superior Oblique dominant (inferior)

Ptosis - Levator palpebra superioris

Pupil Dilation - Unopposed dilator pupillae (under sympathetic control

Loss of reflexes - Ciliary Muscles + Constrictor muscle loss

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14
Q

Where is:

i) Brocha’s Area (+ what does it do)
ii) Sensory Cortex
iii) Motor Cortex (describe the motorcortical representation briefly)
iv) Subarachnoid space (what’s in it)
v) Superior Saggital Sinus
vi) Inferior Saggital Sinus

A

i) Frontal Lobe (inferior frontal gyrus) and controls motor areas of speech
ii) Sensory Cortex is in the parietal lobe (post-central gyrus)
iii) Motor Cortex is in the frontal lobe (pre-central
gyrus) . Motor humonculous - Medially leg –> hand –> face Laterally on opposite side of body.
iv) Subarachnoid Space - between arachnoid meningeal layer and pia mater. contains CSF and Major Blood Vessels
v) Sup. Sagg. Sinus sits in superior border of Falx Cerebri
vi) Inf. Sagg. Sinus sits in inferior border of Falx Cerebri

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15
Q

Meninges

i) Brief Description
ii) Name the dural folds

A

i) Layers covering the central nervous system:

Dura - tough fibrous. Inner - meningeal layer and outer - endosteal ayer

Arachnoid - subdural space is inbetween dura and arachnoid layer. subarachnoid space is between the arachnoid and pia mater.

Pia - Thin layer that closely related to the surface of the brain.

ii) Falx Cerebri - Inter- cerebral hemispheric. Attached anteriorly to crista galli and posteriorly to tentorium cerebelli

Falx Cerebelli - Inter- cerebeller hemispheric

Tentorium Cerebelli - attached anteriorly to (both) posterior clinoid (sphenoid) processes spreading transversely across skull + both anterior clinoid processes.

Diaphragma Sellae - Dural fold forming the pituitary fossa. Stalk of pituitary passes through arpeture in centre.

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16
Q

Venous Sinuses

i) Between what are they situated?
ii) How do they connect + respectively where are they located ?
iii) What drains into the IJV

A

i) Between the inner meningeal dura layer and the outer endosteal dura layer
ii) Sup. Saggital Sinus (Sup. Falx Cerbri) - Drains the sup. cerebral veins

Inf. Sag. Sinus (Inf. Falx Cerebri) - Drains the med. cerebral veins

Straight Sinus (Inf. Post. Falx Cerebri) - Receives Inf. Sag. Sinus + Great Cerebr. Vein

Transverse Sinus (Post. Tent. Cerebell) - Receives Straight Sinus + Sup. Sag. Sinus.

Cavernous Sinus - Lies on sphenoid bone (anteriorly - superior orbital fissure posteriorly - petrous temporal bone.

Sup. Petrosal Sinus - Drain the cavernous sinus into the sigmoid sinus.

Inf. Petrosal Sinus - Drain the cavernous sinus into the IJV

Sigmoid Sinus - Continuation of transverse sinus passing through the jugular foramen then enters IJV

iii) IJV - Inf. Petrosal Sinus

Veins - pharyngeal, facial, lingual, sup. thyr., med. thyr.

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17
Q

Cavernous Sinus

i) Location
ii) Contents

A

i) Located overlying the sphenoid bone extending from sup. orbital fissure -> Petrous temporal bone

Sphenoid bone (endosteal dura mater) - medial

Temporal Bones + (Meningeal Dura mater) - lateral

Meningeal Dura Mater - Roof

Remember the sinuses are contained beneat the endosteal and meningeal dura mater

ii) Contains ICA (+ Carotid Plexus) and CN VI

BUT on the lateral wall lying close to the sinus:

CN III, CN IV, CN Va, CN Vb

Mnemonic- O TOM CAT (CAT - Carotid + Abducens)

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18
Q

Cavernous Sinus Thrombosis:

I) Features

ii) Causes (briefly)

A

i) Features

Oedema - conjuctiva and eyelids

Raised intraocular pressure - papilloedena + retinal haemorrhage

Exophthalmus

Ophthalmoplegia

ii) Infectious Causes - Infeciton transmitted through:

a) Face via anterior facial vein + Ophthlamic Veins

b) Deeper via pterygoid venous plexus

Usual thrombotic risks

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19
Q

Base of Skull

1-11

A

1. Foramen Magnum 2. Incisive Fossa

3. Greater palatine foramen

4. Lesser palatine foramen

5. inferior orbital fissure

6. Foramen ovale 7. Pterygoid Hamulus

8. Carotid Canal 9. Foramen Lacerum

10. palatinovaginal canal 11. Foramen Spinosum

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20
Q

Base of Skull 2

12 - 25

A

12. Stylomastoid Foramen 13. Jugular foramen

14. Mastoid Foramen 15. Mandibular Fossa

16. Vomer and Chonoae 17. Palatine fossa

18. infratemporal crest of great sphenoid wing

19. Mastoid process

20. External occipital protuberance

21. Sup. Nuchal Line 22. Inf. Nuchal Line

23. Petrous Temporal Apex

24. Occipital Condyle 25. External occipital Crest

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21
Q

Cortex Anatomy

1 - 12

A

1. Longitudinal Fissure 2. Sylvian Fissure

3. Lateral Ventricles 4. Third Ventricle

5. interpeduncular cistern 6. Pons

7. medulla oblongata

8. middle cerebellar peduncle

9. corpus collosum 10. Corona Radiata

11. Septum Pallucidum 12. Caudate nucleus

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22
Q

Cortex Anatomy

13-25

A

13. internal capsule 14. External Capsule

15. Claustrum 16. External caps./insula

17. Insula 18. amygdala 19. Cerebral Peduncle

20. Mamillary Body 21. Thalamus

22. Body of fornix 23. Choroid Plexus

24. Putamen 25. Globus Pallidus

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23
Q

Branches of:

i) vertebral arteries
ii) basilar artery
iii) internal carotid arteries

A

i) Vertebral Branches

  • Ant. and Post. Spinal Arteries
  • PICA

ii) Basilar Branches

  • AICA
  • Labryinthine ARtery
  • Superior Cerebellar Artery
  • PCA

iii) ICA Branches (MAIN)

C6 (ophthalmic portion) - Ophthalmic

C7 (Communicating portion) - PCOM, Anterior choroidal before terminating into ACA + MCA

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24
Q

MCA occlusion - signs

A

i) Banford Criteria for stroke but broadly -

Contralateral - arm+face weakness / altered sensation

Speech (if dominant) - Brocha’s (expressive aphasia) Wernicke’s (receptive aphasia)

Neglect (if non-dominant) - of the contralteral side of the body

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25
Q

i) Functions of CN VII

ii) why is there a difference between UMN and LMN VII palsy

A

i) Motor - Muscles of face + Stapedius

Sensory - Taste to anterior 2/3 of tongue

PNS - Submandibular, Sublingual, Lacrimal and Nasal glands

ii) UMN there is scalp + orbicularis oculi sparing as these muscles have a bicortical representation

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26
Q

UMN vs LMN Lesion

A

UMN:

Spastic paresis, minimal wasting, hyperreflexia

LMN:

Flacid paresis, marked wasting, hyporeflexia, fasciculations

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27
Q

Label

A
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28
Q

Neuronal Pathways:

i) Spinothalamic

ii) Dorsal Columns Pathway

A

i) Noiceptors triggered–> C fibers mainly carry signal to dorsal spinal root —> Synapse with substantai gelatinosa –> Decussate at or just above level of entry —-> ascend in contralateral spinothalamic tract and then synapse in the thalamus before somatic organisation in the cortex.

Crude touch, pain + temperature

ii) Sensory nerve cells triggered (meissner’s corpuscles, merkel cells, pacinian corpuscle) –> travel up ipsilateral spinal cord in gracilis (LL) tract or cuneate (UL) tract to medulla oblongata where they synpase —> then decussate forming medial leminiscus before travelling into thalamus and then sorted somatically to the cortex.

29
Q

i) Anterior Cord Syndrome

ii) Posterior Cord Syndrome

iii) Central Cord Syndrome

iv) Brown - Sequard Syndrome

A

i) Ant. Spinal Artery disruption.

This causes interruption of corticospinal pathway and spinothalamic pathway

Loss of pain, temperature sensation + power

ii) Post. Spinal arteries (there are two) Disruption.

This causes interruption of the dorsal columns pathway.

Ataxia (due to loss of proprioception) + loss of soft touch

iii) Central Tumours + Syringomyelia

Loss of pain/temperature sensation at level (decussating spinothalamic fibers)

Arm>Leg weakness (expanding lesions cause involvement of lateral corticospinal tracts)

iv) Brown Sequard Syndrome

Ipsilateral loss of power (corticospinal) + finetouch/proprioception/vibration (dorsal columns)

Contralateral loss of pain/temp/crude (spinothalamic)

30
Q

i) What are lissauer’s tracts?

ii) Which thalamic nucleus do the dorsal column - medial leminiscus + spinothalamic pathways synapse in?

iii) How do the neuron’s post - VPL nucleus innervate the cortices?

iv) Describe the corticospinal tract

A

i) Lissauers tracts are ascending tracts of the spinothalamic pathway immediately as the peripheral nerve enters the spinal cord (ipsilateral)

The lissauer’s tract THEN synapses in substania gelatinosa

ii) Ventral Postero-Lateral Nucleus

iii) They travel through the posterior limb of the internal capsule

iv) Orinate in PMC (precentral gyrus orinating from broddman’s areas 1-6) –> Descend through posterior limb internal capsule + crus cerebri –> medullary pyramids most tracts decussate —> descend contralterally and synapse on ventral horn before of spinal level the secondary neuron leaves at

31
Q

Describe spinocerebellar tracts

A

Carry Proprioceptive Information

i) Anterior spinocerebellar tract (Below L2)

  • Primary cell bodies in DRG (1st synapse) –> decussate in spinal cord and then travel contralaterally to superior cerebellar peduncle where they decussate again –> deep cerebblar nuclei

ii) Dorsal Spinal Cerebellar Tract (L2-T1)

  • Enters spinal cord and ascends ipsilaterally until synapsing in clarke’s nucleus at about T1 –> Continue to ascend ipsilaterally and enter cerebellum through inferior cerebellar peduncle

iii) Cuneocerebellar Tract (above T1)

  • Enters spinal cord and then ascends ipsilaterally until synapsing in accessory cuneate nucleus in medulla –> continue ipsilaterally and enter cerebellum through inferior cerebellar peduncle
32
Q

Vertebra

1-16

A

1. vertebral body 2. Transverse process

3. Superior articular facet 4. Cut edge pedicle

5. Vertebral body - anterior

6. Vertebral body - posterior

7. pedicle 8. spinous process

9. Cut edge of lamina

10. Anterior longitudinal lig.

11. Annulos Fibrosis 12. Post. Long. Lig

13. Supraspin. Lig. 14. Interspin. Lig.

15. lig. flavum 16. Basivertebral Foramen

16. Nucleus pulposus

33
Q

Commonest level for:

i) Spondylolisthesis

ii) Disc Herniation

iii) What type of joint is a IV Disc

A

i) L5- Spondylolisthesis

ii) L5/S1 - Disc herniation (disc herniation usually occurs in a posterolateral direction) (L4/L5, C5/C6, C6/C7)

- Herniating discs effect the spinal nerve BELOW So L4/L5 –> effects L5 spinal nerve

iii) Secondary cartilaginous joint

34
Q

Vertebrae numbers + Characteristics :

i) Cervical

ii) Thoracic

iii) Lumbar

iv) Sacral

v) Coccyx

A

i) 7 Cervical (C1- Atlas C2 - Axis)

a) Small body b)Large Vertebral Canal - thin lamina forming triangular canal c) transverse foramen for vertebral art, vein and plexus d) bifid spinous process

ii) 12 Thoracic

a) Sup/Inf. Demi facets + costal facets for ribs (not 11th and 12th ribs) b) Quite prominent dorsal spinous process c) intermediate body size that increases inferiorly

iii) 5 Lumbar

a) large body b) Spinous process points posteriorly

c) chunky lamina

iv) 5 Sacral (usually fused)

v) 3 coccygeal

35
Q

Atlantoaxial joint

A

1, Odontoid Process 2. Body of C2

3. Anterior Tubercle 4. Arch of C1

5. Transverse foramen 6. Upper articulation of skull

7. Transverse process of C2

8. Lamina 9. Spinous Process 10. Vertebral Canal

36
Q

LL Dermatomes - where to check

A

L1 - Inguinal

L2 - Upper thigh

L3 - med/lat knee

L4 - Med leg

L5 - Dorsum of foot (not lateral)

S1 - Lateral foot

S2 - Medial posterior thigh

S3-S5 - anal dermatomes

37
Q

Upper and Lower Limb Myotomes

A
38
Q

Causes of Cauda Equina Syndrome

A

Compression - Disc herniation, Tumour (intrinsic/extrinsic), fracture, degenerative disease, penetrating trauma

Stretch - Spondylolisthesis

Inflamation - Arachnoiditis, demyelination

Toxins - rarely seen with anaesthetic use

39
Q

i) L3/L4 Disc Herniation Presentation

ii) L4/L5

iii) L5/S1

A

i) Pain

Signs: - L4 Nerve root

Sensory Loss - Posterolateral thigh, ant/ knee, medial leg

Weakness - quadriceps, dorsiflexion of foot, hip abductors

Reflex deficit - Knee

ii) Pain

Signs: - L5 Nerve root

Sensory Loss - Lateraal leg, Dorsum of foot (Not lateral)

Weakness - Dorsiflexion of foot, Extension of 1st MCP

iii) Pain

Signs - S1 Nerve root

Sensory loss - lateral foot, heel and sole, posterior leg and thigh.

Weakness - Plantarflexion + Foot eversion

Reflex - deficit in ankle reflex

40
Q
A
41
Q

Briefly Describe vertebrae structure

A

Consist of a:

Body - Has a superior and inferior end plate which articulate with intervertebral discs (Annulus fibrosis peripherally and nucleus pulpsosus centrally). Body has cancellous bone covered by cortical bone

Vertebral Arch -

Formed from the pedicles arising laterally from the body (thin and long cervically, short and fat lumbar). Laterally from the pedicles arise transverse processes. At this point dorso-medially the bone is known as the lamina which meet in the midline again. Where they meet the dorsal spinous process originates pointing dorsally.

Articulation -

Facet joint - superior articular facet of inferior vertebra and inferior articular facet of superior vertebra. The facets are processes on the pedicle also.

IV Joints - Between endplates and IV Discs

Ribs - Here the costal tubercle sits in between the superior demi-facet on the inferior vertebra and the inferior demi-facet on the superior vertebra. The shaft of the rib articulates with the costal facet on the transverse process.

42
Q

Optic Canal:

What Runs Through?

A

Optic nerve (3 Layers of meninges)

Ophthalmic Artery

43
Q

Foramen Magnum:

What runs through?

A

Nervous- Spinal accessory nerve, Medulla Oblongata

Arteries - Vertebral, Posterior spinal, Anterior spinal

Connective tissue - Apical ligament of dens, tectorial membrane

44
Q

What is this?

What runs through?

A

Jugular Foramen:

Vascular: Inf Petrosal Sinus/Sigmoid Sinus –> IJV

Meningeal branch of the ascending pharyngeal art.

Nerves: IX,X,XI

45
Q

Carotid Canal:

i) Structures running through
ii) Branches of structure running through

Foramen Lacerum:

iii) Structures running through

A

i) Internal Carotid Artery-

Courses through the carotid canal (temporal bone)

Enters middle cranial fossa ( superior to the foramen lacerum - not actually in the foramen lacerum)

ii) ICA Branches -

Choroidal Art., Opthalmic Art, MCA, ACA, PCOMM

iii)

Artery - of pterygoid canal, meningeal branch of ascending pharyngeal

Vein - Emissary veins (route for infection to cause cavernous sinus thrombosi)

Nerves - Nerve of pterygoid canal (Greater petrosal nerve joins deep petrosal nerve)

46
Q

Tongue:

Nerve Supply

A

Nerve Supply -

CNXII

Except

Palatoglossus - CNIX + CNX

47
Q

i) What is this?

ii) What goes through it ? - describe route and branches of this structure

A

i ) Stylomastoid Foramen

ii) Facial Nerve - Facial nerve orginates at the pontinemedullar junction and has a motor nucleus / Special sensory component. These fibers then coalesce —>

Exit the cranial cavity through IAM and travels in the facial canal within petrous temporal bone. —>

Now some branches are given whilst in the canal

1) Greater petrosal nerve
2) Nerve to stapedius
3) Chorda tympani (which joins the lingual nerve of CNV3)
4) Auricular Branch

—> then exits the canal through stylomastoid foramen and gives off five major branches beneath the cover of parotid gland

1) Temporal 2) Zygomatic 3) Buccal 4) Marginal Mandibular Nerve 5) Cervical

48
Q

What are the divisions of the trigeminal nerve

A

CNVI - Ophthlamic Nerve

Lacrimal, Frontal, Nasociliary

CNV2 - Maxillary Nerve

Pterygopalatine ganglion, then becomes infraorbital nerve (Gives superior alveolar nerve)

CNV3 - Mandibular Nerve

Otic Ganglion, Auriculotemporal nerve, Inferior Alveolar Nerve, Lingual Nerve (submaxillary ganglion), Buccinator, Mylohyoid Nerve (Anterior Digastric + Mylohyoid)

49
Q

Structures passing through superior orbital fissure

A

Nerves- CN III, IV, V1 (Some branches), VI

Arteries - Branches of middle meningeal/lacrimal arteries

Veins - Opthalmic Vein

50
Q

What is this?

What runs through it?

A

Foramen Ovale

CNV3

Accessory Meningeal Artery

Lesser Petrosal Nerve

51
Q

What is this?

What runs through?

A

Foramen Spinosum (lateral and posterior to foramen ovale)

Middle Meningeal Artery

52
Q

Arteries:

i) ICA enters through the … which is lateral to the …

ii) … lies posterior to the clivus and is formed at the ..

A

i) ICA enters through the foramen lacereum (alongside artery of pterygoid canal and nerve of pterygoid canal) which is lateral to the clivus)
ii) Basilar artery lies posterior to the clivus and is formed at the junction between pons and medulla

53
Q

Orbit:

i) Name the bones making up the orbit?

ii) Structures passing through SOF

iii) Structures passing through IOF

iv) N Supply to lacrimal gland

A

i) 7 Bones - Frontal, Maxillary, Sphenoid, Palatine, Lacrimal, Zygomatic, Ethmoidal

ii) Ophthalmic Vein, CN III, IV, V1 - Frontal, Lacrimal, nasociliary, VI,

iii) CNV2 - Infraorbital, Zygomatic.

Inf. Ophthalmic Veins, Branches of pterygopalatine ganglion

iv) PNS - Pterygopalatine. SNS - Carotid Plexus. GSS- Lacrimal Branch V1

54
Q

Cranial Sutures:

i) When do cranial sutures ossify?

ii) Condition where cranial sutures are fused at birth?

iii) What bones form pterion?

iv) MMA enters the skull through which foramen?

v) Foramen Lacerum lies lateral to ..

vi) Name the cranial Sutures.

A

i) Cranial Sutures Ossify between 18-24 months
ii) Craniosynostosis
iii) 4 - Frontal, Parietal, Temporal, Sphenoid
iv) Spinosum
v) Clivus
vi) Metopic Suture (between frontal bones), Coronal Suture (between frontal/parietal bones), Saggital suture ( between parietal bones), Lamboid Suture (between parietal and occipital bone)

55
Q

Boundaries of the middle cranial fossa

A

Anterior:

Lesser wing of sphenoid

Anterior Clinoid process

Anterior Chiasmatic Groove

Posterior:

Greater wing of sphenoid

Petrous Temporal Bone

Squamous Temporal Bone ( laterally)

Dorsum Sellae

56
Q

Sella Turcica:

i) Where is it

ii) What lies in it

iii) Which sinus is in close proximity? - It’s Contents

iv) Thrombosis of this sinus is Caused By

A

i) Sphenoid bone behind the chiasmatic groove in the middle cranial fossa.

Inferiorly - known as the hypophyseal fossa housing the pitutiary gland

Posteriorly - is the dorsum sellae and the clivus

ii) Houses the pituitary gland

iii) Cavernous Sinus - Paired structures lie laterally to the sella turcica

Drains - Ophthalmic Veins + Sphenoparietal sinus

Drains into - Inf. + Sup. Petrosal sinuses

Contents (O TOM CAT)- Running through ICA + CN VI

On lateral wall - CN III, IV, VI, VII

iv) Thrombosis - Spreading infection from facial areas drained by Facial + Ophthalmic Veins

57
Q

Formane Magnum:

i) Structures running through

A

i) Structures - Medulla Oblongata, apical lig. of dens, tectorial membrane

Vessels - Vertebral Arteries, Ant. Spinal Art. Post. Spinal arteries.

Nerve - Spinal CN XI, sympathetic plexus surrounding the vertebral artery.

58
Q

Describe configuration of the foramina of the middle cranial fossa

A

Through/Adjacent to the sphenoid bone:

Optic Canal - Formed between the medial lesser wing and body of sphenoid

Superior Orbital Fissure - Formed between the lesser wing (sup.) and greater wing (inf.)

Now Rotundum, Ovale + Spinosum all through greater wing.

Rotundum - Most anterior and medial

Ovale - Largest, posteriolateral to rotundum

Spinosum - Posteriolateral to ovale

Lacerum - In between the posterior dorsum sellae of the posterior portion of sphenoid/ clinoid process of occipital bone/medial petrous temporal bone

59
Q

Describe the configuration of foramina of the posterior cranial fossa

A

Foramen Magnum - Occipital Bone

Hypoglossal Canal - Occipital Bone on rim of the Foramen Magnum hidden by the occipital condyles.

Internal Accoustic Meatus - lateral to the occipital bone (clivus) through the petrous temporal bone

Jugular Foramen - Bounded anterior but the petrous temporal bone and posteriorly by the occipital bone.

60
Q

Spinal Arteries:

i) Gross Description + what they supply

ii) Segmental arterial supply

iii) Anterior Cord Syndrome

A

i) Grossly -

Posterior Spinal Arteries - Vascularise Dorsal Third

Anterior Spinal ARtery - Vascularise Anterior 2/3rds

ii) Segmental Arterial supply comes from -

cervical, intercostal and lumbar arteries

iii) Beck’s Syndrome - Interrupted blood supply to anterior spinal artery –> Loss of spinothalamic tract and corticospinal tract

61
Q

Vertebral Arteries:

i) Which is larger

ii) Describe the parts

A

i) Left is generally larger

ii) 1st Part (preforaminal) - Anterior to C7 Vertebra and Sympathetic Trunk

2nd Part (foraminal) - C2-C6 Transverse Foraminae

3rd Part (atlantic) - C1 Transverse Foramina

4th Part (Intracranial) - Passes through dura through formaen magnum. Travels anterior to medulla oblongata and they join bilaterally and pontomedullary junction to form basilar artery

62
Q

i) Branches of Basilar Artery

ii) Where are cerebral artery aneurysms found usually?

iii) Modes of presentation of Basilar Artery Aneurysm

A

i) Pontine Arteries, Anterior Inferior Cerebellar Artery, Posterior Cerebral Arteries, Superior Cerebellar Artery

ii) 1. AComm/ACA + ICA/PComm (30-35% a piece)

  1. MCA Bifurcation (20%)
  2. Basilar Artery Bifurcation + Posterior Circulation (5% each)

iii) Most often - Acute SAH

Less often - Bitemporal Hemianiopia

63
Q

Which veins do various sinuses drain:

SUperior saggital sinus

Inferior Saggital Sinus

Cavernous Sinus

Sphenopalatine Sinus

Transverse Sinus

Straight Sinus

A

Superior Saggital Sinus - Superior Cerebral Vein

Inferior Saggital Sinus - Medial cerebral Veins

Cavernous Sinus - Superficial middle cerebral vein, Inferior Cerebral vein

Sphenopalatine Sinus - Superficial middle cerebral vein

Transverse Sinus - Inferior Cerebral vein

Straight Sinus - Great Cerebral Vein

64
Q

Boundaries of :

i) ANterior Cranial Fossa

ii) Middle cranial fossa

iii) Posterior cranial fossa

A

i) Anterior Cranial fossa -

Anterior - Frontal,

Posterior Medially - ethmoid

Posteriolaterally - sphenoid bones (greater wings)

ii) Middle Cranial Fossa -

Anteriorly - Lesser wings of sphenoid and limbus of sphenoid (medially)

Posterior - Laterally Petrous Temporal bone + Medially dorsum sellae of sphenoid bone

iii) Posterior Cranial Fossa -

Anteriorly - Laterally petrous temporal bone + Medially dorsum sellae of sphenoid bone

Posteriorly - Occipital Bone

Floor - Occipital bone + some temporal bone

65
Q

Label

A
66
Q

Describe motor + Sensory Humunculous

A
67
Q

Joints/ Ligaments of the atlanto-axial joint

A

Transverse ligament of the atlas:

This runs transversely between two lateral masses close to the anterior arch.

Apical ligament of the atlas:

From the odontoid process of the axis to the foramen magnum

Alar (paired) ligaments of the odontoid process:

from the sides of the dens to the occipital tubercles (medial side of the occipital condyle)

Anterior atlanto-axial ligament

From the Anterior arch of atlas to the body of the axis

Posterior atlanto-axial ligament

From the posterior arch of the atlas to the lamina of the axis

Lateral atlanto - axial joints - Paired joints between inferior articular facet of Atlanto (C1) and superior articular facet of Axis (C2)

Medial Atlanto-axial joint - Between the articular facet of C1 and the dens of C2

68
Q

Jefferson’s Fracture

Hangman’s Fracture

A

Jefferson’s Fracture:

Fall on to extended neck

Lateral masses of C1 compress between Occipital condyles and Axis leading to fracture of Anterior/Posterior Arch of the Atlas

Hangman’s Fracture:

Sudden decelleration injury

Fracture of the lateral atlanto-axial joints (Inferior atlas facets + superior axis facets)

MRCS Part B (11 decks)

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