Unit 4 Flashcards
1
Q
Sensory or Motor: (I) Olfactory nerve
A
Sensory
2
Q
Sensory or Motor: (II) Optic nerve
A
Sensory
3
Q
Sensory or Motor: (III) Oculomotor n.
A
Motor
4
Q
Sensory or Motor: (IV) Trochlear n.
A
Motor
5
Q
Sensory or Motor: (V1)Trigeminal- Ophthalmic division
A
Sensory
6
Q
Sensory or Motor: (V2) Trigeminal- Maxillary division
A
Sensory
7
Q
Sensory or Motor: (V3) Trigeminal- Mandibular division
A
Both
8
Q
Sensory or Motor: (V) Trigeminal nerve
A
Both
9
Q
Sensory or Motor: (VI) Abducens nerve
A
Motor
10
Q
Sensory or Motor: (VII) Facial nerve
A
Both
11
Q
Sensory or Motor: (VIII) Vestibulocochlear nerve
A
Sensory
12
Q
Sensory or Motor: (IX) Glossopharyngeal nerve
A
Both
13
Q
Sensory or Motor: (X) Vagus nerve
A
Both
14
Q
Sensory or Motor: (XI) Accessory nerve
A
Motor
15
Q
Sensory or Motor: (XII) Hypoglossal nerve
A
Motor
16
Q
What is the foramen of the Olfactory (I) nerve?
A
Cribiform foramina in cribiform plate
17
Q
What is the foramen of the Optic (II) nerve?
A
Optic canal (foramen)
18
Q
What is the foramen of the Oculomotor (III) nerve?
A
Superior orbital fissure
19
Q
What is the foramen of the Trochlear (IV) nerve?
A
Superior orbital fissure
20
Q
What is the foramen for the Opthalmic division (V1) of the Trigeminal nerve?
A
Superior orbital fissure
21
Q
What is the foramen for the Maxillary division (V2) of the Trigeminal (V) nerve?
A
Foramen rotundum
22
Q
What is the foramen for the Mandibular division (V1) of the Trigeminal nerve?
A
Foramen Ovale
23
Q
What is the foramen of the Abducens (VI) nerve?
A
Superior orbital fissure
24
Q
What is the foramen of the Facial (VII) nerve?
A
Internal acoustic meatus, through facial canal, exits at stylomastoid foramen
25
What is the foramen of the Vestibulocochlear (VIII) nerve?
Internal acoustic meatus
26
What is the foramen of the Glossopharyngeal (IX) nerve?
Jugular foramen
27
What is the foramen of the Vagus (X) nerve?
Jugular foramen
28
What is the foramen of the Accessory (XI) nerve?
Jugular foramen
29
What is the foramen of the Hypoglossal (XII) nerve?
Hypoglossal canal
30
This bone is part of the axial skeleton and is composed of 22 bones: 8 form the cranium and 14 are associated with the face
The skull
31
What are the unpaired bones of the cranium?
Frontal bone, occipital bone, sphenoid bone, ethmoid bone
32
What are the paired bones of the cranium?
Parietal bones and temporal bones
33
The calvaria is composed of what bones?
Frontal bone, parietal bones, occipital bone
34
These are very short fibers connect the interlocking edges of articulating bones and are the joints between bones of the skull. What are these?
Sutures
35
What are the major sutures?
Coronal suture, squamosal suture, lambdoidal suture, saggital suture
36
What are the paired bones of the face?
Nasal, maxillae, zygomatic, lacrimal, palatine, inferior nasal conchae
37
What are the unpaired bones of the face?
Vomer, mandible
38
The hard palate is formed by:
1. Palatine processes of the maxillae
2. Horizontal plates of the palatine bones
39
What are the paranasal sinuses?
1. Frontal sinus
2. Sphenoid sinus
3. Ethmoid sinus
4. Maxillary sinus
40
How is the zygomatic arch formed?
The zygomatic process of temporal bone + temporal process of zygomatic bone
41
This is the area superior and deep to the zygomatic arch. What is this?
Temporal fossa
42
This is the area inferior and deep to the zygomatic arch. What is this?
Infratemporal fossa
43
What bones make up the orbit?
1. Frontal bone
2. Zygomatic bone
3. Maxillary bone
4. Sphenoid
5. Ethmoid
6. Lacrimal bone
7. Palatine bone
44
The nasal septum is composed of:
1. Perpendicular plate of the ethmoid bone
2. Vomer bone
3. Septal cartilage
45
These are soft fibrous areas where several sutures unite and allow for molding and remodeling. What are these?
Fontanelles
46
What is included in the fontanelles?
Anterior fontanel, posterior fontanel, mastoid fontanel, mastoid fontanelles, sphenoid fontanelles
47
What are the 3 primary germ layers:
- Endoderm
- Mesoderm
- Ectoderm
48
Germ layers form through a process known as __________________
Gastrulation
49
True or False: The development of the nervous system occurs in the ectoderm
True
50
What are the four main events occurring during neurulation?
1. Formation of neural plate
2. Shaping of neural plate
3. Invagination of neural plate
4. Closure of neural groove (forms the neural tube and neural canal)
51
Brain & spinal cord develop from proliferating cells in the ___________________
Neural tube
52
The __________________ forms the brain
Cranial end if the neural tube
53
The ___________________ forms the spinal cord
Caudal end
54
The ventricular system & central canal of the spinal cord develop from ______________
Neural canal
55
The neurons are ___________
Excitable cells
56
The neuroglial cells are ____________
Supportive cells
57
What are the cell bodies of the CNS?
Nucleus
58
What is the cell body of the PNS?
Ganglion
59
What is the axon of the PNS?
Nerve
60
This is compose primarily of myelinated axons. What is this?
White matter
61
What is composed of neuronal cell bodies, dendrites, unmyelinated axons, & neuroglia
Gray matter
62
Central cavity surrounded by gray matter which is surrounded by white matter. What is this?
Basic Patterning of CNS
63
The central cavity surrounded by a gray matter core with white matter external to the gray matter. What is this?
Spinal cord
64
This area is similar to the spinal cord but with additional areas of gray matter. Scattered gray matter is seen within the white matter and the cerebrum and cerebellum also have outer layer of gray matter called the cortex. What is this?
The brain
65
What is the elevated fold of the brain called?
Gyrus
66
What is the shallow groove between gyri called?
Sulcus
67
What is the deep groove between gyri?
Fissure
68
Each hemisphere of the brain is divided into five lobes. What are they?
1. Frontal
2. Parietal
3. Temporal
4. Occipital
5. Insular
69
What are the 3 basic regions of each hemisphere?
- cerebral cortex
- internal white matter
- basal nuclei
70
What are the functions of the cerebral cortex?
Conscious thought, speech, memory, evaluation of sensory input, personality, initiation of voluntary motor movement
71
What is the function of the motor area of the cortex?
Initiation of movement
72
What is the function of the sensory area of the cortex?
Reception of sensory information and perception
73
What is the function of the association areas?
Complex integrative functions
74
These are fibers connecting gray areas between the two hemispheres. What are these called?
Commissural fibers
Ex: Corpus callosum
75
These are fibers connecting different parts of same hemisphere. What are these called?
Association fibers
Ex: General cerebral white matter
76
These are fibers connecting the cerebral cortex to the other parts of the CNS. What are these called?
Projection fibers
Ex: Spinal tracts
77
____________ is a collection of nerve cell bodies deep in the cerebrum
Basal nuclei
78
What is the function of the Basal nuclei?
Influence motor function by regulating the initiation and termination of movement. Inhibits extraneous muscle contraction and helps to maintain motor control.
79
Damage in the basal nuclei can lead to _________ and ______________
Muscle rigidity, resting tremors
80
This is the major relay center for all sensation entering the cerebral cortex EXCEPT olfaction. Aids in motor activity. What is this?
Thalamus
81
This is the major regulator of the body’s internal environment, through the automatic, limbic and endocrine systems. What is this?
Hypothalamus
82
This helps to regulate sleep-wake cycle with the hypothalamus (main projection is the pineal body), which secretes the hormone melatonin. What is this?
Epithalamus
83
The brain stem consists of three regions:
Midbrain & Pons & Medulla Oblongata
84
What is the function of the brain stem?
Produces the autonomic behaviors necessary for survival, provides a pathway for axons ascending and descending
85
What are the projections and budges from midbrain:
1) cerebral peduncles
2) superior colliculi
3) inferior colliculi
86
Where is the midbrain located?
The white matter are pigmented nuclei (substantia nigra)
87
Associated Cranial Nerve Nuclei
1) Oculomotor (III)
2) Trochlear (IV)
88
Major component of pons are conduction tracts that course between:
1) higher brain centers and the spinal cord
2) motor cortex and cerebellum
89
Associated Cranial Nerve Nuclei
1) Trigeminal (V)
2) Abducens (VI)
3) Facial (VII)
4) Vestibulocochlear (VIII)
90
What is the function of the medulla Oblongata?
Autonomic reflex center housing important visceral motor nuclei
91
Projections from the medulla Oblongata:
1) Pyramids
2) Gracile tubercle
3) Cuneate tubercle
92
Associated Cranial Nerve Nuclei:
1) Vestibulocochlear
2) Glossopharyngeal
3) Vagus
4) Portion of Accessory
5) Hypoglossal
93
What is the function of the cerebellum?
Provides timing and patterns of skeletal muscle contractions for smooth and coordinated movements; also provides error correcting feedback for movements
94
Anatomical Parts:
1) Cerebellar Hemispheres
2) Vermis
3) Arbor Vitae
4) Folia
5) Anterior Lobes
6) Posterior Lobes
7) Flocculonodular Lobes
95
Three Cranial Meninges (from superficial to deep)
1) Dura Mater
2) Arachnoid Mater
3) Pia Mater
96
What are the two parts of the dura mater in skull?
Periosteal Layer and Meningeal Layer
97
What is the periosteal layer?
Superficial layer- absent in vertebral column
98
What is the meningeal layer?
Deeper layer; continuous in vertebral column as rural sheath of spinal cord
99
What is the meningeal layer of dura mater that forms double-layered folds that insert into fissures called?
Dural septa
100
What is the space created where the two layers of the dura mater separate and contain venous blood from the veins of the brain and CSF returned from the subrtachnoid space called?
Dural Venous Sinuses
101
This the space between the skull and the dura mater
Extradural
102
The what is the space between the dura and arachnoid mater?
Subdural space
103
What is the space between the arachnoid and pia mater
And location of CSF and blood vessels around the brain
Subarachnoid space
104
Ventricles arise from ______________ of the neural tube
Lumen
105
This is paired C-shaped lateral ventricles?
Telencephalon
106
This is the third ventricle of the brain
Diencephalon
107
This is the cerebral aqueduct
Mesencephalon
108
What is the fourth ventricle of the brain
Myelencephalon
109
Lumen associated with neural tube which will become the spinal cord forms the ___________
Central canal
110
All the ventricles contain ___________ , a structure that continually
Choroid plexus
111
What are the functions of the CSF?
- serves as a shock absorber
- Helps in the transport nutrients and removal of waste
- Helps maintain the proper ion balance in neural tissue
112
This is caused by obstruction of circulation of CSF and leads to accumulation of fluid that compresses the brain
Hydrocephalus
113
Two major pairs of arteries supply the brain. What are they?
Vertebral and Internal carotid arteries
114
This artery branches off the subclavian arteries, travels through the transverse foramina and enters skull through foramen magnum, and its branches are referred to as the posterior circulation of the brain. What is this?
Vertebral artery
115
This artery **branches off the common carotid artery** , **enters the skull through carotid canal and** then through the **internal opening of foramen lacerum**. Its **branches are referred to as the anterior circulation of the brain**. What is this?
Internal carotid arteries
116
What are the major branches of the vertebral artery?
Posterior inferior cerebellar artery, anterior spinal artery, basilar artery
117
What are the major branches of the internal carotid artery?
Anterior cerebral arteries, middle cerebral arteries, posterior communicating arteries
118
The Circle of Willis is composed of what arteries?
Anterior communicating artery, anterior cerebral artery, internal carotid artery, posterior communicating arteries, posterior cerebral arteries
119
This artery is the terminal branch of the **internal carotid**, enters the longitudinal fissure, and supplies most of the medial and superior surfaces of the cerebral hemispheres
Anterior cerebral artery
120
This artery is the terminal branch of internal carotid artery, ** passes between the temporal and frontal lobes to reach the lateral part of the cerebral hemispheres**, supplies lateral surface of cerebral hemispheres. What is this?
Middle cerebral artery
121
This artery is the **terminal branch of basilar artery** and supplies inferior surface of the cerebral hemispheres and all of the occipital lobes. What is this?
Posterior cerebral artery
122
This serves as communication between the brain and PNS. It extends from the foramen magnum to approximately the L1 or L2 vertebrae level. What is this?
Spinal cord
123
What is the distal tapered end of the spinal cord?
Conus medullaris
124
This is the collection of spinal nerve roots extend inferior to spinal cord. What is this?
Cauda equina
125
This is the extension of pia mater from the conus medullaris anchoring to the posterior surface of coccyx. What is this?
Filum terminale
126
What are the two major enlargements of the spinal cord?
Cervical enlargement (C5-T1) and Lumbosacral enlargement (L1-S3)
127
The spinal cord is protected via:
Bones, meninges, CSF
128
What are the three meningeal spaces:
Epidural space, Subdural space, Subarachnoid space
129
Cell bodies of ____________ located in ventral horn
Motor neurons
130
True or False: Axons of motor neurons exit spinal cord through ventral root ——> spinal n. ——> ventral OR dorsal ramus ——-> through named nerves to effector
True
131
Cell bodies of ____________ locates in dorsal root ganglia
Sensory neuron
132
True or False: Axons from peripheral receptors of sensory neurons enter through dorsal OR ventral ramus ———-> spinal nerve ————-> dorsal root —————-> synapse with interneuron in dorsal horn
True
133
The white matter of the spinal cord consists largely of organized myelinated axons organized into ___________ or _______________
Tracts, fasciculi
134
What is the cell body of the CNS?
Nucleus
135
What is the axon of the CNS?
Tract or Fasciculus
136
What is the cells body of the PNS?
Ganglion
137
What is the axon of the PNS?
Nerve
138
_____________________ are pathways that carry sensory information from the periphery toward the brain.
Ascending/sensory/afferent tracts
139
_________________ are pathways that carry motor commands from the brain into the spinal cord.
Descending/motor/efferent tracts
140
True or False: Ascending Sensory Tracts bring the sensory information from the periphery to the brain
True
141
Each system consists of 3 neurons forming the pathway:
Primary neuron, secondary neuron, tertiary neuron
142
This neuron is the cell body locates in dorsal root ganglion.
Primary neuron
143
This neuron is axons crossed-over to contralateral side
Secondary neuron
144
This neuron is the cell body located in thalamus. What is this?
Tertiary neuron
145
Located in the posterior (dorsal) portion of the spinal coord white matter. What is this?
Dorsal column system
146
Dorsal column carries _______________ information from the body to the postcentral gyrus
General sensory
147
The dorsal column system consists of two tracts that both occupy the dorsal portion of the spinal cord. What are they?
Fasciculus gracilis & fasciculus cuneatus
148
Axons from the LL and lower trunk reside in this and contains sensory information from below spinal cord level T6. What tract is this?
Fasciculus gracilis
149
Axons from the UL and upper trunk reside and contains sensory information from spinal cord level T6 and above. What tract is this?
Fasciculus cuneatus
150
In the dorsal column system, tertiary neuron cell body is located in the ________________. Axons from the thalamus carries information to the _______________________
Thalamus, postcentral gyrus
151
In the dorsal column, the secondary neuron cell body located in the ________________ or _________________ of the medulla. Axons from these neurons cross over to the ____________________ in the medulla oblongata and these synapse in the thalamus.
Gracile, cuneate nucleus, contralateral side
152
In the dorsal column, the primary neuron cell body located in the _________________. Enters the __________________ or ____________________ and ascends. Synapses in the medulla oblongata at the _______________ or ____________
Dorsal root ganglion, fasciculus gracilis, fasciculus cuneatus, gracile, cuneate nucleus
153
_________________ is located in the lateral portion of the spinal cord white matter.
Lateral spinothalamic tract
154
Lateral spinothalamic tract carries ________________ from the body to the postcentral gyrus.
Pain and temperature
155
In the lateral spinothalamic tract, the tertiary neuron is in the ________________. Axons from the thalamus carries information to the _________________
Thalamus, postcentral gyrus
156
In the lateral spinothalamic tract, the secondary neuron is in the _________________ adjacent to the corresponding dorsal root ganglion. Axons from this neuron cross over within 1-2 spinal segments to the __________________ of the cord and ascend
dorsal horn of gray matter, contralateral side
157
In the lateral spinothalamic tract, the primary neuron is in the ___________________. Synapses in the __________________ of the spinal cord IMMEDIATELY upon entering the cord
Dorsal root ganglion, dorsal horn
158
Descending motor tracts take motor information from the ___________________ to the _________________.
Brain, periphery
159
For primary neurons, cell body is located in the ______________.
Cortex
160
For the secondary neuron, cell body is locates in the ________________.
Spinal cord gray matter
161
The lateral corticospinal tract originates at the __________________.
Precentral gyrus
162
In the lateral corticospinal tract, the primary neuron in the precentral gyrus referred as _________________. Axons travel within the _________________ of the medulla on the ipsilateral side, then cross over to the contralateral side just superior to the beginning of the spinal cord.
Upper motor neurons, pyramids
163
In the lateral corticospinal tract, the secondary neuron in the ________________ of gray matter, referred to as _____________________. Axons from this neuron run through the ventral roots, spinal nerves and dorsal and ventral rami to peripheral muscles
Ventral horn, lower motor neurons
164
The eye is composed of:
Three tunics, internal chambers, lens
165
What are the three tunics?
Fibrous, vascular, sensory
166
The fibrous tunic is composed of:
Sclera and cornea
167
The vascular tunic is composed of:
Choroid, ciliary body, iris
168
The central opening of the iris is the ___________
Pupil
169
The sensory runic (or retina) is composed of:
Pigmented layer and neural layer
170
True or false: each optic nerve contains half of each visual field information
True
171
True or False: Right optic nerve carries 1/2 of right visual field (nasal portion) info & 1/2 of left visual field (temporal portion)
True
172
True or False: left optic nerve carries 1/2 right visual field (temporal portion) info & 1/2 of left visual field (nasal portion)
True
173
At the _______________, fibers from the nasal aspect of each eye cross over
Optic chiasma
174
True or False: Each optic tract carries the information from the contralateral visual field.
True
175
True or False: Right optic tract carries the information for the LEFT visual field
True
176
Left optic tract carries the information for the RIGHT visual field
True
177
Most fibers in the optic tracts synapse with neurons in the _________________ body in the thalamus
Lateral geniculate body
178
Fibers from the _____________ project from optic radiation to the __________________ in the ______________
Thalamus, primary visual cortex, occipital lobes
179
Right primary cortex integrates information from the _________________
Left visual field
180
Left primary cortex integrates information from ____________________
Right visual field
181
True or False: Superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior oblique are all extrinsic muscles of the eye
True
182
What is the action of the superior rectus muscle?
Elevation of eyeball
183
What is the innervation of the superior rectus muscle?
Oculomotor nerve
184
What is the action of inferior rectus muscle?
Depression of eyeball
185
What is the innervation of inferior rectus muscle?
Oculomotor nerve
186
What is the action of the medial rectus muscle?
Adduction of eyeball
187
What is the innervation of the medial rectus muscle?
Oculomotor nerve
188
What is the action of the lateral rectus muscle?
Abduction of eyeball
189
What is the innervation of the lateral rectus muscle?
Abducens nerve
190
What is the action of the superior oblique muscle?
Depression & adduction of eyeball
191
What is the innervation of the superior oblique muscle?
Trochlear nerve
192
What is the action of the inferior oblique muscle?
Elevation and abduction of eyeball
193
What is the innervation of the inferior oblique muscle?
Oculomotor nerve
194
What is the special sensory innervation for taste (anterior 2/3 of tongue)?
Facial nerve
195
What is the general sensory innervation of tongue (anterior 2/3 tongue)?
Mandibular division of Trigeminal nerve
196
What is the special sensory for taste AND general sensory (posterior 1/3 of tongue)
Glossopharyngeal nerve
197
What are the extrinsic muscles of the tongue?
Styloglossus m. , hyoglossus m. , genioglossus m.
198
All the extrinsic muscles of the tongue are innervates by what nerve?
Hypoglossal nerve
199
What does the styloglossus muscle do?
Elevates & retracts the tongue
200
What does the hyoglossus muscle do?
Depresses the tongue
201
What does the genioglossus muscle do?
Protracts the tongue
202
Two main destinations of these impulses (pathway for smell):
Primary olfactory cortex and subcritical route to the hypothalamus, amygdala, and other regions of limbic system
203
___________________ is located mostly at the medial aspect of the temporal lobe; conscious awareness of odors and has connections to orbitofrontal cortex for identification and discrimination of odors
Primary olfactory cortex
204
_____________________________ elicits emotion and memory, evoked responses to the odors
Subcortical route to the hypothalamus, amygdala, and other regions of limbic system
205
What are the structures of the middle ear?
Auditory ossicles (malleus, incus, stapes), pharyngotympanic tube
206
What are the structures of the external ear?
External auditory canal, auricle
207
What are the structures of the internal ear?
Semicircular canals, cochlea, oval window, round window
208
What are the muscles of the facial expression?
Frontalis muscle, occipitalis muscle, orbicularis oculi muscle, orbicularis oris muscle, buccinator muscle, platysma muscle
209
What are the muscles of facial expression innervates by?
Facial nerve
210
What are the five motor branches of the facial nerve?
Temporal, zygomatic, buccal, marginal mandibular, cervical
211
What does the frontalis muscle do?
Draws scalp anteriorly, raises eyebrows, and wrinkles forehead
212
What does the occipitalis muscle do?
Draws scalp posteriorly
213
What does the orbicularis oculi muscle do?
Closes the eye
214
What does the orbicularis oris muscle?
Closes & protrudes lips
215
What does the buccinator muscle do?
Presses the cheek against teeth
216
What does the platysma muscle do?
Tenses skin of neck and draws out part of lower lip inferiority & posteriorly
217
What are the muscles of mastication?
Masseter muscle, temporalis muscle, medial pterygoid muscle, lateral pterygoid muscle
218
What are the muscles of mastication innervated by?
Mandibular division of the Trigeminal nerve
219
What does the temporalis muscle do?
Elevates and retracts mandible
220
What does the masseter muscle do?
Elevates mandible
221
What does the lateral pterygoid muscle do?
Depresses, protracts, & moves the mandible from side-to-side
222
What does the medial pterygoid muscle do?
Elevates, protracts, and moves the mandible from side-to-side
223
What are the neck muscles?
Trapezius muscle & sternocleidomastoid muscle
224
What is the innervation of the neck muscles?
Accessory nerve
225
What is the origin of trapezius muscle?
Superior unchallenged line, external occipital protuberance , ligamentum nuchae, spinous process C7 & T1-T12 vertebrae
226
What is the insertion of the trapezius muscle?
Lateral 1/3rd of clavicle, acromion & spine of scapula
227
What is the action of the trapezius muscle?
Elevates and retracts scapula
228
What does the sternocleidomastoid do?
Bilaterally, flexes, cervical portion of vertebral column, unilaterally, rotates head to the side opposite the contracting muscle
229
What do the suprahyoid muscles do?
All elevate the hyoid bone
230
What are the suprahyoid muscles?
Mylohyoid, digastric muscles, stylohyoid muscles, geniohyoid muscles
231
True or False: the suprahyoid muscles are located superior to the hyoid bone
True
232
True or False: infrahyoid muscles are located inferior to the hyoid bone
True
233
What are the infrahyoid muscles?
Sternohyoid muscle, omohyoid muscle, sternothyroid muscle, thyrohyoid muscle
234
What do the infrahyoid muscles do?
All depress the hyoid bone
235
What are the blood vessels of the head & neck?
Common carotid artery, internal carotid artery, external carotid artery, vertebral artery
236
What are the blood vessels of the head & neck?
Common carotid artery, internal carotid artery, external carotid artery, vertebral artery
237
What does the common carotid artery do?
Bifurcates into the internal & external carotid arteries
238
What does the internal carotid artery do?
Ascends towards base of skull; gives off NO branches in the neck and forms the anterior circulation of the branch
239
What does the external carotid artery do?
Gives off many branches in the neck and supplies external neck and face
240
What does the vertebral artery do?
Branches off the subclavian artery, forms posterior circulation of the brain
241
What are the major veins of the head & neck
External jugular veins and internal jugular vein
242
What does the external jugular vein do?
Located superficial to the sternocleidomastoid muscle and is formed from the veins of the external face head and neck
243
What does the internal jugular vein do?
Located deep to the sternocleidomastoid muscle, returns venous blood from inside the skull
