Scalp (1-14)

Question 1

Name the layers of the scalp;

Answer 1

SCALP - Skin, Connective tissue, Aponeurosis, Loose areolar tissue, Perisoteum

Question 2

In which layer of the scalp is the neurovascular bundle located;

Answer 2

Connective tissue

Question 3

Through which layer of the scalp do soft tissue infections spread and why?;

Answer 3

Loose areolar tissue because it contains emissary veins (valveless veins which connect the extracranial veins of the scalp to the intracranial dural venous sinuses.

Question 4

Name six arteries that supply the scalp;

Answer 4

3 branches of external carotid: Superficial temporal (frontal & temporal region), posterior auricular (around auricle), occipital (back of scalp). Branch of Internal Carotid: Opthalmic artery (anterior scalp) which branches into supraorbital & supratroclear arteries

Question 5

Name nerves that supply sensation to the scalp;

Answer 5

Opthlamic (branch of Trigeminal) nerve branches: Supratrochlear (anteromedial forehead), Supraorbital (top of scalp), zygomaticotemporal (temple), auricotemporal (around auricle).
Cervical nerve branches: Lesser occipital (posterior ear), Great occipital (occipital region, third occipital nerve (below occipital region)

Question 6

What are the signs and symptoms of giant cell arteritis (GCA)?;

Answer 6

Generalised- Malise, fatigue, night sweates, low grade fever, weight loss. Localised- headaches, visual problems, jaw pain, scalp tenderness

Question 7

What eye conditions are associated with GCA;

Answer 7

Anterior ischaemic optic neuropathy (AION), posterior ischaemic optic nueropathy (PION), amaurosis fugax

Question 8

What three investigations would you perform in a patient with suspected GCA?;

Answer 8

Bloods: ESR, CRP, WCC. US of scalp. Temporal artery biospy (definitive ix) - need multuple biopsies

Question 9

What would be the histological features of an arterial biopsy of GCA?;

Answer 9

Grannulatomis infammation, prescence of giant cells in tunica media, fibroid necrosis, destruction of elastic membrane + smooth muscle (atrophy), neovasculasisation

Question 10

Which nerve is at risk when you perform a temporal artery biospy?;

Answer 10

Temporal branch of facial nerve

Question 11

What is the key medical therapy in the treatment of GCA?;

Answer 11

Steroids (Prednisolone 1mg/kg) - tapering dose. Tx for 1-2 years total

Question 12

What are the signs and symptoms of trigeminal neuralgia?;

Answer 12

V1 V2 V3 (manidular most common affected). May be localised to one nerve or all three. Sudden, unilateral, intermittent, sharp pain. Does not cross the midline

Question 13

Name two drug that can be used to treat trigeminal neuralgia;

Answer 13

Carbamezapine, Lamotrigine (Bacolfen and gabapentin not as commonly)

Question 14

What surgical option is available for treating trigeminal neuralgia;

Answer 14

Gamma knife radiation to damage trigeminal nerve. Microvascular depression