Ventricles and Meninges

Question 1

structure that sits in the tentorial notch

Answer 1

midbrain

Question 2

arterial supply of the dura and hematoma associated with it

Answer 2

meningeal arteries (largest is middle meningeal)
epidural hematoma

Question 3

which meninge is the most sensitive

Answer 3

dura mater

Question 4

most dura is supplied by

Answer 4

branches of trigeminal nerve

Question 5

posterior fossa is supplied by

Answer 5

vagus nerve, 2nd and 3rd cranial nerve

Question 6

stimulation/irritation of dura

Answer 6

pain to eye, temple, forehead

Question 7

stimulation/irritation to posterior fossa

Answer 7

pain to ear, back of head and neck

can occur with cervical muscle tension

Question 8

herniation under falx cerebri

Answer 8

midline shift/mass effect

Question 9

what happens in midline shift

Answer 9

large hematoma in supratentorial compartment on the left may cause displacement on left cerebrum under falx cerebri to the right side

Question 10

left cerebrum under falx cerebri

Answer 10

supratentorial compartment

Question 11

pressure built up in supratentorial compartment where brain tissue is displaced inferiorly through the tectorial notch, displacing the midbrain against the free edge of the tentorium

Answer 11

tentorial herniation

Question 12

often produces coma and severe neurological dysfunction associated with high mortality

Answer 12

tentorial herniation

Question 13

causes downward shift of brain and brainstem through foramen magnum and occurs in infratentorial compartment

Answer 13

herniation of cerebellum and brainstem through foramen magnum

Question 14

during TBI, movement of brain inside cranial cavity can cause lacerations of the brain tissue as it moves against sharp edges of dural septa

Answer 14

herniation of cerebellum and brainstem through foramen magnum

Question 15

structures involved in the absorption of CSF and where does this occur

Answer 15

arachnoid villi in the superior sagittal sinus

extensions of arachnoid membrane; function as one-way valve

Question 16

which structures produce CSF and where does this occur

Answer 16

choroid plexus produces CSF within ventricles

formed by extensions of inner layer of pia mater

Question 17

primary production of CSF occurs in the

Answer 17

lateral ventricles

Question 18

CSF flow

Answer 18

1. Produced in Choroid Plexus / Lateral Ventricles
2. Interventricular Foramen of Monro
3. Third Ventricle
4. Cerebral Aqueduct
5. 4th Ventricle
6. Median Aperture and 2 Lateral Apertures
7. Subarachnoid Space: down around spinal cord, up around brainstem and cerebrum
8. Superior Sagittal Sinus

Question 19

abnormalities in CSF composition

Answer 19

Increased white blood cells
(Indicates pathology: infection, tumor, etc.)
Increased protein content
(Indicates pathology:
Abnormal immunoglobin proteins in MS)
Blood in CSF
(May be indicative of subarachnoid hemorrhage)

Question 20

tear in meningeal arteries as a result of skull injury

outside the inner layer of dura; provide no blood supply to brain tissue

Answer 20

epidural hematoma

Question 21

epidural hematomas distort surrounding brain tissue and cause an

Answer 21

increase in intracranial pressure

likely to be fatal

Question 22

tearing of a cerebral vein within subdural space

veins bleed slowly and do not usually cause symptoms

Answer 22

subdural hematoma

Question 23

similarities between the 2 hematomas

Answer 23

symptoms are caused by pressure on the brain, NOT anoxia
Both can be fatal if not properly tended to
Both are within layers of the dura

Question 24

differences between the 2 hematomas

Answer 24

Epidural = artery bleed (rapid)
Subdural = vein bleed (slow)

Question 25

What is the normal value of ICP?

Answer 25

5-15 mm HG

Question 26

3 forms of hydrocephalus

Answer 26

communicating, non-communicating, normal pressure

Question 27

no obstruction to flow within the ventricles; excess fluid due to increased production or decreased absorption

Answer 27

communicating hydrocephalus

Question 28

occurs after a subarachnoid hemorrhage *blood clots in arachnoid villi (or meningitis)

Answer 28

communicating hydrocephalus

Question 29

obstruction to flow of CSF within the ventricles; bulging of meninges in SC/brain block flow

Answer 29

non-communicating hydrocephalus

Question 30

often associated with congenital narrowing of cerebral aqueduct, spina bifida, TBI, posterior fossa tumors

Answer 30

non-communicating hydrocephalus

Question 31

only occurs in elderly, presents with normal or low pressure but ventricles enlarge

Answer 31

normal pressure hydrocephalus

Question 32

4 classic signs of normal pressure hydrocephalus

Answer 32

lethargy, confusion, incontinence, difficulty walking

Question 33

common treatment of hydrocephalus

Answer 33

ventriculo-peritoneal shunt (placed in lateral ventricle)

Question 34

signs and symptoms of increased ICP

Answer 34

Headache
Lethargy
Nausea and/or Vomiting
Weakness, motor control problems, increased tone
Significant changes in vital signs
Seizure activity
Cranial vault enlargement (only seen in children prior to closure of sutures)

Question 35

precautions of increased ICP

Answer 35

AVOID: isometric muscle contractions and Valsava maneuvers (increase ICP)
Patients are typically restricted to supine and have orders not to sit up
Watch for orders regarding angle of head of bed
Pain will increase ICP and should be minimized
Exercises may be performed (if ordered) as long as ICP does not increase > 10 mm Hg [guideline not rule]

Question 36

tumor arising from arachnoid cells (most common benign tumor)

Answer 36

meningioma

Question 37

do not affect brain tissue cells directly but do cause damage due to compression

Answer 37

meningioma

Question 38

meningioma’s occur __ and are more common in __

Answer 38

late in adulthood, women