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Anatomy > Skull, Cranial Anatomy > Flashcards

Skull, Cranial Anatomy Flashcards

1
Q

What are the 8 bones of the neural skull (neurocranium)?

A 
2 parietal
2 temporal
1 frontal
1 occipital 
1 sphenoid
1 ethmoid
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2
Q

What re the 14 facial bones?

A 
2 maxillae 
2 palatine
2 nasal
2 inferior conchae
2 zygomatic bones
2 lacrimal bones
1 vomer
1 mandible
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3
Q

What is the lambdoid suture?

A

The separation between the parietal/occipital and temporal/occipital bones

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4
Q

What is the sagittal suture?

A

The separation between the two parietal bones

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5
Q

What does the the anterior cranial fossa contain?

A

Inferior/anterior frontal lobes

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6
Q

What does the middle cranial fossa contain?

A

Temporal lobes and serves to anchor the tentorial fold of the dura mater. It also contains the sella turcica (Turkish saddle) for the pituitary gland and many passages for nerves and vessels.

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7
Q

What does the posterior cranial fossa contain?

A

Cerrebellum
Pons
Medulla oblongata
Foramen magnum

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8
Q

What contains the cristae galli?

A

Ethmoid

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9
Q

Where are the clinoid process and the sella turcica located?

A

On the sphenoid bone

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10
Q

Where is the internal occipital ridge life?

A

In the occipital bone

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11
Q

What bone contains the petrous ridge?

A

Temporal bone

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12
Q

What are the sites of vulnerability that may be filed and compress the brain?

A
  1. Epidural space
  2. Subdural space
  3. Arachnoid granulations
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13
Q

Where does the middle meaning artery enter the skull?

A

The foramen spinosum

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14
Q

Where is the weakest point on the side of the skull

A

Pterion

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15
Q

What are the consequences of an epidural hematoma?

A
  1. Depression of ant. Choroidal artery
  2. Compression of post. Cerebral artery
  3. Medial displacement of middle cerebral vessel and Sylvia point
  4. Compression of 3rd nerve leading to homolateral pupil dilation, ptosis, and 3rd nerve muscle palsy
  5. Herniation of cerebellum tonsil, depression of post. Inf. Cerebellar artery
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16
Q

On which tract can an epidural hematoma impinge?

A

Cortico-spinal tract

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17
Q

Difference between subdural and epidural hematoma?

A

Subdural is venous and epidural come from artery supply

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18
Q

What are some things that can cause subdural hematoma?

A

Symptom of shaken baby syndrome

Roller coaster syndrome

(Hard shaking )

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19
Q

What are the consequences of a stage 1 concussion?

A

Irregular protein and neurofibillary tangles

Headaches, depression, etc.

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20
Q

What are the consequences of a stage 2 concussion?

A

More tangles (brain damage)

When in frontal cortex, associated with headaches, depression, mood swings, explosive tendencies, etc

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21
Q

What are the consequences of a stage 3 concussion?

A

More tangles than stage 2.

Damage to frontal cortex, associated with problems in judgement, planning etc…

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22
Q

What are the consequences of a stage 4 concussion?

A

End stage Disease with paranoia, dementhia, aggressive tendencies, etc.

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23
Q

How does CSF exit the 4th ventricle?

A

Foramen of Luschka

Foramen of Magendie

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24
Q

What does the anterior fontanelle separate?

A

The single frontal and the two parietal bones

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25
Q

What does the sphenoidal fontanelle separate?

A

The area between the sphenoid, parietal, temporal, and frontal bones

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26
Q

What does the mastoid fontanelle separate?

A

The area between the temporal, occipital and parietal bones

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27
Q

Is pulsation of a fontanelle normal?

A

Yes

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28
Q

What can indicate pathology on a fontanelle?

A

Deformations such as a bulge or depression

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29
Q

What replaces the fontanelles and by when?

A

By 18 to 24 months the fontanelles are replaced through intramembranous ossification

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30
Q

What are the sutures of the neurocranium formed by?

A

The closures of the fontanelles

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31
Q

What can premature closure of fontanelles lead to?

A

Cranio-facial abnormalities such as Crouzon syndrome

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32
Q

When is the growth of the facial skull usually complete?

A

When all teeth have emerged.

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33
Q

What are the 3 foramina on the face that the trigeminal nerve exits from?

A

V1: supra-orbital
V2: infra-orbital
V3: mental foramina

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34
Q

What bone can be mistaken for a fracture in posterior view?

A

The Wormian bone

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35
Q

What forms the anterior fossa??

A

Frontal, ethmoid and the body and lesser wings of the sphenoid bone

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36
Q

Where does the butterfly shaped middle fossa of the skull extend to?

A

From the crest of the sphenoid bone anteriorly, the greater wings of the sphenoid, and the squamous parts of the temporal bones laterally, and the petrous portion of the temporal bones posteriorly.

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37
Q

What are the boundaries of the posterior fossa?

A

Anterior midline by the dorsum sellae of the sphenoid bone and laterally by the petrous ridge and mastoid region of the temporal bone.

The base is largely composed of the occipital bone and contains the foramen magnum for the exit of the spinal cord.

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38
Q

What are the points of attachment for the dura mater?

A

The crista galli
Clinoid processes
Petrous portions of the temporal bone
Internal occipital ridge

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39
Q

The pterion defines the union of what 4 bones ?

A

The parietal, frontal ,greater wing of the sphenoid and the squamous part of the temporal bone

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40
Q

Why is the pterion a clinically important landmark?

A

Because it overlies the anterior branch of the middle meningeal artery on the internal aspect of the skull

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41
Q

What part of the temporal bone is thin and relatively easy to fracture?

A

The squamous part

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42
Q

What restrains the movement of the brain?

A

The dural folds

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43
Q

What are the two most important dural folds that restrain brain movement?

A

Falx cerebri (between the two cerebral hemispheres)

The tentorium cerebelli

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44
Q

Where does the falx cerebro extend from?

A

The falx begins at the crista galli and extends as a crescent-shaped fold to it termination on the internal occipital ridge

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45
Q

Where does the tentorium cerebelli span from?

A

Emerges as a dural fold from the clinoid processes of the sphenoid and each petrous ridge of the temporal bone to meet the falx cerebri

Note: a midline hiatus allows for the passage of the brain stem

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46
Q

What separates the cerebrum above from the cerebellum?

A

Tentorium cerebelli

47
Q

What covers the pituitary fossa?

A

A small fold, the dosum sellae (compared to tentorium and falx)

48
Q

Where is the epidural space and what can lead to this space being filled?

A

Between the periosteal layer of the dura mater and the skull

Fractures of the skull, specially in the area of the meningeal vessels, can lead to this becoming a real space filled with blood

49
Q

Where is the sub-dural space located and what can lead to this space being filled?

A

Between the arachnoid and dura mater

The major veins of the sub-arachnoid space must traverse this space to access the superior sagittal sinus and are vulnerable to tearing. This sinus is one of many venous channels that are located between 2 layer of dura.

50
Q

Where are the veins that traverse the sub-arachnoid space heading?

A

Superior sagittal sinus

51
Q

Where is the squamous portion of the temporal bone most vulnerable at?

A

At and around the pterion

52
Q

Where do the meninges received their blood supply from?

A

The meningeal blood vessels which receive blood from the external carotid artery and enter the skull through the foramen spinosum (middle meningeal artery)

53
Q

If one or both lamina o the skull are fractured such that the dura is torn in the region of the meningeal artery, what can happen?

A

The vessel will rupture and arterial blood will accumulate in the epidural space resulting in an epidural hematoma.

54
Q

Why does arterial blood form a localized swelling that displaces the brain?

A

Because the outer layer of the dura is tightly adherent to the bone

55
Q

How is the extend of hemadural trauma genereally judged?

A 
By levels of consciousness:
Alert
Stupor
Partial coma
Deep Coma
56
Q

What is the fatality of a hematoma is not rapidly treated?

A

Up to 50% fatal

57
Q

What is commonly seen in a person who suffered from a hematoma?

A

A lucid interval after the injury followed by a rapid deterioration

58
Q

What characteristic does a epidural hematoma show on a CT scan?

A

A lenticular shape

59
Q

When displacement of the temporal lobe of the brain is severe enough in an epidural hematoma, what can occur?

A

The lobe ca herniate over the tentorium onto the brain stem compressing cranial nerve III (oculomotor)
This results in:
Oculomotor palsies
Papillary dilation
Ptosis (drooping eyelid)
Disruption of the cortico-spinal tract leading to motor deficits

60
Q

Where is the subdural space a real space?

A

At the point where the subarachnoid veins enter the superior sagittal sinus

61
Q

How does a subdural hematoma occur?

A

Trauma that causes a shear force that damages a vein as it traverses the sub-dural space. Venous blood will accumulate in the subdural space

62
Q

How does a subdural hematoma look on a CT and how deadly is it?

A

Bright in the CT

Roughly 60% fatal (especially those in a coma). Extend of damage is determined by venous pressure.

63
Q

How can a hematoma present on a patient?

A

Symptoms can be intermittent and include:
Headaches
Lethargy
Slurred speech

64
Q

What is a contusion?

A

A tear in the fabric of the brain that damages blood vessels, glial cells, and neurons and usually leads to motor and sensory deficits

E.g. Trauma-induced Parkinson’s disease

65
Q

What can lead to Parkinson’s disease?

A

Contusions

E.g. Muhammad Ali

66
Q

Is the brain sensitive to pain or pressure?

A

No?

67
Q

What does dilation of blood vessels and irritation of the dura mater cause?

A

Debilitating headaches

68
Q

What nerves innervate the dura mater in the cranium?

A

V, IX and X

69
Q

What is chronic traumatic encephalopathy (CTM)?

A

Accumulation of “minor concussions” which have a cumulative effect that lead to significant impairment. This can only be diagnosed post-mortem by the presence of neurofibrillary tangles.

70
Q

Why does a loss of consciousness after a head injury require a neurological examination?

A

Because more severe types of concussions are accompanied by an extended period of unconsciousness with damage extending into the realm of hematomas.

71
Q

What is a serious consequence of head trauma that may skip over the Glasgow scale?

A

Leakage of CSF

72
Q

What are some high risk for bleeding signs where Ct is recommended?

A

1- a Glasgow score less than 15 2hours after injury
2- skull depression
3- basal skull fracture [blood behind the eardrum]
4- “raccoon eyes”
5- CSF leaking from nose or ears
6- Battle’s sign (bruising behind the ear)

73
Q

What are the criteria in the Glasgow scale?

A
  1. Eye opening
    (spontaneous 4, to loud voices 3, to pain 2, none 1)
  2. Verbal response
    (Oriented 5, confused and disoriented 4, inappropriate words 3, incomprehensible words 2, none 1)
Moto response
(Obeys commands 6, localizes pain 5, withdraws from pain 4, abnormal flexión posturing 3, extensor posturing 2, none 1)
74
Q

What are the 4 ventricles?

A

2 lateral, and a singled 3rd and 4th

75
Q

Where do the anterior and posterior horns of the lateral ventricles extend to?

A

Anterior: into the frontal cerebral hemispheres

Posterior: extend into the temporal lobes

76
Q

What connected the 3rd and fourth ventricle?

A

Iter (aka aqueduct of Sylvius)

77
Q

Where is CSF produced?

A

In the choroid plexuses

78
Q

Where does the CSF produced in the lateral ventricles pass through to reach the 3rd ventricle?

A

2 foramina of Monroe

79
Q

How does the CSF circulate through the subarachnoid space?

A

Pulsation of the cerebral blood vessels

80
Q

What are the arachnoid granulations

A

One way valves where excess CSF exits into the superior sagittal sinus from the subarachnoid space.

81
Q

Why do the arachnoid granulations have poor design?

A

They shut down when venous pressure exceeds that in the subarachnoid space. This can cause the ventricles to expand

82
Q

How much CSF does the sub-arachnoid space hold?

A

150ml whereas 300 ml of CSF is produced each day (min)

83
Q

What can blockage of the iter result in?

A

Hydrocephalus due to blockage of CSF and build up in the lateral and third ventricles

84
Q

What does expansion of the ventricles compress in hydrocephalus?

A

The thalamus, basal ganglia, and the internal capsul

85
Q

What are the symptoms of hydrocephalus and its treatment?

A

Symptoms: progressing headache, nausea, loss of balance, difficulty walking, etc

Treatment: inserting a shunt that passes the CSF from the ventricles to the venous system

86
Q

Any head trauma that results in the leakage of a clear fluid from the nose or ears is?

A

Very serious bruh

87
Q

How is pneumocephalus caused?

A

A fracture of the frontal sinus that allows the CSF to escape though the nose

88
Q

What is a symptom of pneumocephalus?

A

Severe headaches

89
Q

What veins of the superficial temporal veins have direct connections to the venous sinuses?

A

Emissary veins

90
Q

What are the four distinct but inter-connected venous systems of the head?

A
  1. Superficial temporal veins
  2. Diploic veins
  3. Venous sinuses
  4. Major veins of the subarachnoid space
91
Q

Where are the diploic veins?

A

Ramify between the 2 laminate of the skull

92
Q

Where are the venous sinuses?

A

Within the dura mater to drain the brain (they form channels)

93
Q

What are the major veins of the subarachnoid space direct connections to?

A

Capillary networks in the Pía mater that receive blood from the brain

94
Q

Where do the superior cerebral veins drain into?

Where do the inferior cerebral veins drain into?

A
  1. The superior sagittal sinus

2. The inferior sagittal sinus and then the great vein (of Galen) and the straight sinus)

95
Q

Where do the blood from both systems merge? (Sup and inf. Sagittal sinuses)

A

At the confluens of the sinuses in the occipital region

96
Q

Where does the blood go after meeting in the confluens?

A

The blood courses through the transverse and sigmoid sinus on each side to exit the skull in the internal jugular vein

97
Q

The direction of blood vein in the head is dependent o what??

A

The venous pressure because the systems are all interconnected. It is influenced by posture and by the pressure in the CSF

98
Q

What is the most clinically significant sinus because of its location?

A

The cavernous sinus

99
Q

How can infections of the face move into the cavernous sinus where they are difficult to treat?

A

Through the interconnection of the facial, angular, ophthalmic veins with the cavernous sinus

100
Q

What are the characteristics of a pulsating exophthalmos?

A
  1. The eyeball protrudes and retracts with the heartbeat
  2. A pulse in the orbit can be detected and blocked by carotid compression
  3. The flowing of blood (Bruit) can be detected with a stethoscope
101
Q

How can a pulsating exophthalmos occur?

A

By wearing of the wall of the internal carotid artery. This can lead to the formation of an aneurism within the cavernous sinus. If the aneurysm bursts, then the blood pressure in the sinus will be that of the arterial system. This causes a swelling of the ophthalmic veins in the orbit.

102
Q

By what sinus does the carotid artery pass on the way to the brain?

A

The cavernous sinus

103
Q

What can cause interference to the cavernous sinus and the course of neighboring nerves because of its location?

A

Pituitary tumor because the sinus is located on either side of the pituitary gland

104
Q

What is a leading cause of hypertension?

A

Hemorrhagic stroke

105
Q

What are the two types of hemorrhagic strokes?

A

Intracerebral (within the brain)

Subarachnoid

106
Q

How does a hemorrhagic stroke occur?

A

From a weakened vessel that ruptures and bleeds into the surrounding brain. This typically occurs at either an aneurism or an arteriosvenous malformation (AVM)

107
Q

What artery is directly continuous with the middle cerebral artery (MCA)

A

The internal carotid artery

108
Q

What are the branches of the MCA that supply the region of the internal capsul and thalamus?

A

Striate arteries

109
Q

What are the common sites for aneurysm in the Circe of Willis?

A
  1. Anterior communicating artery (30-35%)
  2. Bifurcation of the internal carotid and posterior communicating artery (30-35%)
  3. Bifurcation of Middle cerebral artery (20%)
  4. Basilar artery bifurcation (5%)
  5. Remaining posterior circulation arteries (5%)
110
Q

What are the symptoms of an aneurysm the circle of Willis?

A

Tend to be asymptomatic

When they rupture they cause blinding headaches and can be fatal

111
Q

An embolism that dislodges from a thrombosis in the carotid artery will pass upwards to block what arteries?

A

The striate arteries

112
Q

The ischemia from the blockage of the striate arteries causes what?

A

Will damage the axons passing through the internal capsul thus causing a paralysis and loss of sensation on the opposite side of the body.

113
Q

What is thalamic pain syndrome (Dejerine-Roussy syndome) that can occur after ischemia from a striate artery blockage?

A

Extreme pain with no peripheral source

Anatomy (23 decks)

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