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Neuro > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What are the 2 layers of Dura in the brain?

A

Endosteal (Periosteal)
Meningeal

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2
Q

At what level does the dura matter end?

A

S2

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3
Q

What is the Falx Cerebri and what are its attachments?

A

Sickle-shaped extension of dura matter between cerebral hemispheres (longitudinal fissure)
Attached ant. to Crista Galli
Attached post. to Tentorium Cerebelli

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4
Q

The anastomoses of what 2 veins form the straight sinus?

A

Inf. sagittal sinus + great cerebral vein

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5
Q

What is the Tentorium Cerebelli?

A

Fold of dura matter that arches like a tent above post. cranial fossa, covering cerebellum.
Lifted up by Falx Cerebri.
Supports occipital lobes of cerebral hemispheres.
Tentorial notch is only connection between supra and infra tentorial compartments

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6
Q

What does the post. margin of Tentorium Cerebelli enclose?

A

Transverse Sinuses

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7
Q

What does the Tentorium Cerebelli enclose where it attaches to the upper border of the petrous temporal bone?

A

Superior Petrosal sinuses

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8
Q

What is an Epidural haemorrhage and what may cause it?

A

Haemorrhage into the epidural space. This will not cross suture lines due to the dura being tightly attached.
Caused by rupture of meningeal a.
Surgical emergency

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9
Q

What is an Uncal herniation and what may be a consequence of it?

A

Displacement of uncus of temporal lobe into the tentorial notch.
This will compress ipsilateral crus cerebri (contains corticospinal tract) leading to contralateral motor weakness.

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10
Q

What may cause an Uncal herniation?

A

Epidural haemorrhage

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11
Q

What is the Diaphragma Sellae?

A

Formed by the tentorium cerebelli on the roof of the sella turcica, covering hypophysis, with a central aperture for hypophyseal stalk

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12
Q

Name all structures that pass through the Cavernous sinus

A

CN’s III, IV, Vi, Vii, and VI
Sympathetic fibres
Int. Carotid a.

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13
Q

What makes up the walls of cavernous sinus?

A

Lateral Wall:
Continuation of meningeal layer of dura matter from the middle cranial fossa

Roof:
Diaphragma Sellae

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14
Q

What sensation can dura matter perceive?

A

Pressure and Stretch

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15
Q

What part of the dura is innervated by the Ophthalmic n.?

A

Ant. cranial fossa
Ant. Falx Cerebri
Tentorium Cerebelli

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16
Q

What part of the dura is innervated by recurrent meningeal branch of Maxillary n.?

A

Mid. cranial fossa
Mid region of the vault

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17
Q

Acute meningitis involving post. cranial fossa is associated with what symptoms?

A

Neck rigidity and often head retraction due to reflex contraction of the post. nuchal muscles, which are supplied by cervical nerves

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18
Q

What are Arachnoid granulations?

A

Pierce the dura and enter foveola granulares.
Absorb CSF and return it to venous system via sup. sagittal sinus

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19
Q

What structure is present in the Subdural space?

A

Bridging Veins

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20
Q

At what vertebral level does the dura and arachnoid matter end?

A

S2

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21
Q

What structures are present in the subarachnoid space?

A

Cerebral Arteries
CSF

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22
Q

What is a subdural haemorrhage and what is the cause?

A

Haemorrhage in the subdural space (may cross suture lines.
Rupture of bridging veins

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23
Q

What is the most common cause of a subarachnoid haemorrhage?

A

Ruptured berry aneurysm (85%) on circle of Willis

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24
Q

How will a subarachnoid haemorrhage appear on a CT scan?

A

Blood in basal cisterns, fissures and the depths of cortical sulci

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25
Q

What is the name of the ligaments formed by pia matter between roots of spinal nerves?

A

Denticulate ligaments

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26
Q

At what level does pia matter close, and what does it continue as afterwards?

A

L1/2
Continues as Filum Terminale to S2

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27
Q

What are the lateral ventricles located?

A

Cerebral hemispheres inferior to Corpus Callosum

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28
Q

What structure connects the two lateral ventricles and the 3rd ventricle?

A

Intraventricular foramen

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29
Q

Where is the 3rd ventricle located?

A

In the diencephalon between left and right Thalamus

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30
Q

What structure connects the 3rd and 4th ventricle?

A

Cerebral Aqueduct

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31
Q

Where is the 4th Ventricle located?

A

Between pons, medulla and cerebellum

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32
Q

CSF leaving the ventricles travel through what structure to reach the subarachnoid space?

A

Lateral apertures or the median aperture (both stem from 4th ventricle and exit at the cisterna magna)

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33
Q

CSF is produced in what structure?

A

Choroid Plexus
pia matter + ependymal cells + choroidal vessels

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34
Q

What is Communication hydrocephalus?

A

Flow of CSF blocked after exiting ventricles
OR
Reduced absorption of CSF

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35
Q

What is Non-communicating hydrocephalus?

A

Flow of CSF is blocked

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36
Q

What is a suboccipital puncture and where would it enter?

A

Needle inserted in to the Cisterna magna to obtain CSF or to administer drug/vaccine

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37
Q

What makes the BBB?

A

Astrocyte foot processes
Endothelial tight junctions
Basement membrane

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38
Q

In what structures are there no BBB?

A

Area Postrema
Neurohypophysis
Pineal Gland

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39
Q

What can pass the blood brain barrier?

A

Lipophilic, non-polar molecules
Gases, water, glucose and aa’s

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40
Q

For how long is the BBB defective for after injury?

A

2 to 3 Weeks
(can be taken advantage of with contrast agents for MRI scans)

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41
Q

Name structures

A

^^^

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42
Q

What structures make up the Pharyngeal Apparatus?

A

Pharyngeal arches
Pharyngeal clefts
Pharyngeal pouches

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43
Q

What is an old term that may be used interchangeably with the word “Pharyngeal”?

A

Branchial

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44
Q

What Pharyngeal arch is missing in humans?

A

5th (only in fish)

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45
Q

What are Epipharyngeal Placodes?

A

Ectodermal thickenings, contribute to cranial nerve ganglia

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46
Q

What hard tissues of the cranium does the Neural crest give rise to?

A

Viscerocranium, Frontal, Squamous Temporal

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47
Q

What hard tissues of the cranium does the Paraxial mesoderm give rise to?

A

Parietal, Petrous Temporal, Occipital

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48
Q

What hard tissues of the cranium does the Lateral plate mesoderm give rise to?

A

Laryngeal cartilages

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49
Q

What CN is associated with the 1st pharyngeal arch?

A

Viii (Mandibular division of Trigeminal n.)

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50
Q

What CN is associated with the 2nd pharyngeal arch?

A

VII (Facial)

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51
Q

What CN is associated with the 3rd pharyngeal arch?

A

IX (Glossopharyngeal)

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52
Q

What CN is associated with the 4th pharyngeal arch?

A

X (Superior laryngeal)

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53
Q

What CN is associated with the 6th pharyngeal arch?

A

X (Recurrent laryngeal)

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54
Q

What pharyngeal arches does the hyoid bone originate from?

A

2nd (lesser horn & sup. body)
&
3rd (greater horn & lower body)

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55
Q

What arteries stem from the 1st Pharyngeal arch?

A

Maxillary & external carotid arteries

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56
Q

What arteries stem from the 2nd Pharyngeal arch?

A

Hyoid & stapedial arteries

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57
Q

What arteries stem from the 3rd Pharyngeal arch?

A

Common carotid & first part of the int. carotid arteries

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58
Q

What arteries stem from the left side of the 4th Pharyngeal arch?

A

Arch of aorta from the left common carotid to the left subclavian arteries

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59
Q

What arteries stem from the right side of the 4th Pharyngeal arch?

A

Right subclavian artery (proximal portion)

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60
Q

What arteries stem from the left side of the 6th Pharyngeal arch?

A

Left Pulmonary artery & ductus arteriosus

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61
Q

What arteries stem from the right side of the 6th Pharyngeal arch?

A

Right pulmonary artery

62
Q

What is the name of the 1st pharyngeal Pouch?

A

Tubotympanic recess

63
Q

What is formed from the Tubotympanic recess?

A

Eustachian tube
Tubal tonsil
Middle ear cavity
Tympanic membrane

64
Q

What is formed by the 2nd pharyngeal pouch?

A

Palatine tonsil
Tonsillar fossa

65
Q

What is formed by the 3rd pharyngeal pouch?

A

Inf. parathyroid gland
Thymus (migrates inferiorly)

66
Q

What is formed by the 4th pharyngeal pouch?

A

Sup. parathyroid gland
Ultimopharyngeal body (C cells of thyroid)

67
Q

The remnants of clefts 2, 3 and 4 become what structure, and what does this structure do?

A

Become the Cervical sinus, which usually obliterates

68
Q

What happens if the Cervical sinus doesn’t obliterate?

A

You get a Branchial (Lateral cervical) cyst and fistula
Cyst = no connection to int. or ext. surface
Fistula = connects either ext. or int.
Located ant. to SCM

69
Q

What is the path of neural crest cells?

A

Originate from Hind brain region divisions called rhombomeres before migrating to the pharyngeal arches

70
Q

What is the pattern of neural crest cells migrating to the pharyngeal arches?

A

R1/2 to arch 1
R4 to arch 2
R6/7 to arches 3,4,6

71
Q

What are the odds of having a Craniofacial defect at birth?

A

1/500

72
Q

Describe Treacher Collins syndrome

A

Autosomal Dom.
1st / 2nd arch syndrome
Defective protein called Treacle
Failure of formation of neural crest cells and migration into 1st and 2nd pharyngeal arches

73
Q

List symptoms of Treacher Collins syndrome

A

Abnormal eye shape
Microganthia (underdeveloped jaw)
Conductive hearing loss
Underdeveloped zygoma
Malformed ears

74
Q

Describe Di George syndrome

A

22q11 deletion
3rd & 4th pouches fail to develop = thalamus and parathyroids defective

75
Q

List Symptoms of Di George syndrome

A

Cardiac abnormality (especially tetralogy of fallot)
Abnormal facies
Thymic aplasia - infection prone
Cleft palate
Hypocalcaemia

76
Q

What is Craniosynostosis?

A

Range of syndromes where cranial sutures close prematurely
FGF receptor mutations cause imbalance in mesenchymal proliferation at sutures = premature closure

77
Q

What do you get with inadequate and excessive SHH function?

A

Cyclopia and Diprosopus

78
Q

What is the most common cause of Traumatic Brain Injury (TBI)?

A

Falls - 47%

79
Q

What is the ratio of men/women for TBI’s?

A

M 1.5/1.0 F

80
Q

What is the treatment for TBI?

A

No real treatment (only for secondary stuff)

81
Q

When assessed pre admission, 50% of TBI cases will have what?

A

SpO2 < 90%

82
Q

What are the GCS score catagories?

A

Mild 13-15
Moderate 9-12
Severe < 8

83
Q

What 3 things are assessed in a GCS?

A

Eye opening
Verbal response
Motor response

84
Q

How do you assess eye opening in a GCS?

A

1-4
4. Open spontaneously
3. Open to speech
2. Open in response to pressure
1. Do not open
NT. can’t assess

85
Q

How do you assess verbal response in GCS?

A

1-5
5. Orientated
4. Confused
3. Inappropriate words
2. Incomprehensible sounds
1. No response to verbal and physical stimuli
NT. can’t be assess

86
Q

How do you assess motor response in a GCS?

A

1-6
6. Obeys response
5. Localises to central pain
4. Normal flexion toward source of pain
3. Abnormal flexion
2. Extension to pain
1. No response to painful stimuli

87
Q

What symptoms of TBI warrant going to hospital?

A

Under 5 / Over 65
Amnesia
Loss of consciousness
High energy injury
Vomiting
Seizure
Bleeding / Clotting disorders

88
Q

What are examples of Secondary brain injuries in TBI?

A

Neurotransmitter release (glutamate)
Free radical generation
Calcium mediated damage
Inflammatory response
Mitochondrial dysfunction
Early gene activation

89
Q

Define Secondary Brain Injuries in the context of TBI

A

Secondary processes which occur at the cell & molecular level to exacerbate neurological damage

90
Q

How do you minimise secondary brain injury in TBI?

A

Optimise Oxygenation
Optimise Cerebral Perfusion
Blood glucose
Hypocapnia / Hypercapnia
Body temp

91
Q

How do you calculate Cerebral Perfusion pressure?

A

Mean art. pressure - Intracranial pressure

92
Q

What features suggest an individual is at risk of intracranial mass?

A

High impact injury
Significant retrograde amnesia
History of coagulopathy
Post traumatic seizure
GCS of 12/15 or less
Clinical signs of skull fracture

93
Q

What is a sign of ant. cranial fossa fracture?

A

Peri-orbital bruising

94
Q

What is a sign of Petrous temporal bone fracture?

A

Battle’s sign

95
Q

When should you immediately request a CT scan in TBI?

A

GCS<13 on initial assessment
GCS<15 two hours after injury
Open or suspected depressed skull
Any sign of Basal skull injury
Post traumatic seizure
Vomiting
Amnesia for events over 30mins before event

96
Q

What are common traits of an Extradural Haematoma?

A

Associated w/ skull fracture
Middle meningeal a. damage
1/3 due to venous bleeding
Biconvex on scan

97
Q

What are common traits of a Subdural Haemorrhage?

A

20-30% of brain injuries
Rupture of bridging veins
Crescentic appearance on scan

98
Q

What are common traits of a Subarachnoid Haemorrhage?

A

Assoc. w/ ruptured aneurysm of circle of willis
More commonly caused by head injury

99
Q

What are common traits of an Intracerebral Haemorrhage?

A

Stretching & shearing injury
Impact on inside of skull
Often contrecoup injury

100
Q

What are the clinical signs of herniation (in brain)?

A

Dilated or unreactive pupils
Extensor posturing
Decrease in GCS of 2 or more points

101
Q

What are the most common headaches?

A

Migraine
Muscular tension
Analgesia overuse
Systemic illness
Cervicogenic

102
Q

What are some of the most serious causes of headaches?

A

Subarachnoid haemorrhage
Raised intercranial pressure
Low intercranial pressure
Infection - Meningitis
Temporal Arteritis
Cerebral venous sinus thrombosis

103
Q

What are some treatments for Tension headaches?

A

-Reassure the severity (or lack there of) to the patient
-Reduce analgesia (paracetamol / ibuprofen)
-Low dose amitriptyline (10-20mg)

104
Q

What kind of headache is most associated with nausea?

A

Migraine

105
Q

What other symptoms come along with Migraines?

A

Photophobia, phonophobia and gut symptoms
+/- Aura (visual issues around periphery ie. scotoma)

106
Q

What are the two types of Scotoma, and what are they associated with?

A

Black and white - Migraine
Coloured - Epilepsy

107
Q

What are thought to be causes of Migraines?

A

Vascular and neural theories (mechanisms unclear)

108
Q

Treatments for Acute Migraine?

A

—Triptans—
(agonists at 5HT-1b and 5HT-1d receptors)
Aspirin, paracetamol, anti-nausea (metoclopramide)

109
Q

Prophylaxis for Migraines

A

Beta blockers, low does amitriptyline, Pizotifen
ect.

110
Q

What is an example of Migraine treatment that doesn’t use medication?

A

Botox injection (back of neck/head)
Acupuncture

111
Q

What is contraindicated in women with migraines and aura, and why?

A

Oral contraceptive pill due to risk of stroke

112
Q

A cluster headache is a common type of what?

A

Trigeminal Autonomic Cephalagia (TAC)

113
Q

Symptoms of Cluster headache

A

Unilateral often around the eye
Striking circadian rhythm, same time of day
More common in males

114
Q

Symptoms of Paroxysmal hemicrania (type of TAC)

A

More common in women
Shorter more frequent attacks
responds to indomethacin

115
Q

Treatments of TACs

A

Triptans
Oxygen - high dose
High dose verapamil (up to 960mg/day)

116
Q

What may cause a medication overuse headache?

A

Using too much simple analgesia >15 days/month
or
>10 days for other acute eg. triptans

117
Q

What is a thunderclap headache?

A

Instant or rapid onset (<60 sec) very severe pain
Possible sub-arachnoid haemorrhage
CT head for blood immediately
Can be exertional (often during sex) due to migraine from vasospasm, quickly reversible

118
Q

Give examples of early morning headaches

A

Cervicogenic + Sleep apnoea w/ CO2 retention

119
Q

Causes of Cervicogenic headache

A

Poor posture when sleeping
Over exertion
Spinal degeneration
Usually muscular

120
Q

Causes of Sleep apnoea w/ C02 retention

A

Obesity
History snoring - common w/ alcohol
Treated w/ +ve pressure Oxygen (mask)

121
Q

What is the presentation of raised intracranial pressure and what may be a potential cause?

A

Headache (mild)
Diurnal variation
Often mild nausea

Abscess or CSF blockage

122
Q

Presentation of meningitis?

A

Fever
Rash that doesn’t leave when pressed by glass
Photophobia

123
Q

Treatment for Meningitis

A

Benzyl penicillin

124
Q

Presentation of Temporal arteritis

A

Never below 50 y/o
Jaw claudication (jaw pain on chewing)

125
Q

How to test for Temporal arteritis?

A

Palpate temporal arteries for tenderness (if not tender, probably not temp arteritis)

126
Q

Treatment for Temporal arteritis

A

Use high dose steroids early (note it is hard to get them off as they enjoy them)

127
Q

Presentation of Cerebral venous sinus thrombosis

A

Often F on oral contraceptive pill
Headache
Raised intercranial pressure
MRI of head shows haem bilaterally and empty delta sign

128
Q

Cause of low intercranial pressure

A

Following lumbar puncture (not immediate)
due to CSF leakage through hole left in dura

129
Q

Presentation of low intercranial pressure

A

Headache on standing, eased w/ lying
Can develop into fits as the brain is supported less
If left can cause death

130
Q

Treatment of low intercranial pressure

A

Blood patch for post-LP headache - stops leaking

131
Q

Name all strucures

A

^^^

132
Q

What are the functions of the basal ganglia?

A

-Smooth movement
-Switching behaviour
-Reward system
-Linked to thalamus, cortex, limbic system

133
Q

What is the neostriatum?

A

Caudate nuc. + Putamen
(dorsal striatum)

134
Q

What are the 2 pathways of the Motor loop?

A

Direct & Indirect pathways

135
Q

Stimulation of the direct pathway causes what?

A

Movement

136
Q

Stimulation of the Indirect pathway causes what?

A

Inhibits Movement

137
Q

What receptors are present in the striatal neurons on the Direct & Indirect pathway?

A

D1 - Direct
D2 - Indirect
(dopamine)

138
Q

What specifically happens in the direct pathway of the basal ganglia?

A

Cortical excitation of neostriatum leads to disinhibition of thalamic nuc.
Movement follow activation of putamen by cortical areas

139
Q

What specifically happens in the indirect pathway of the basal ganglia?

A

Cortical excitation of neostriatum leads to inhibition of inhibitory input to subthalamus.
Activation of indirect pathway leads to inhibition of cortical areas

140
Q

Give examples of clinical problems with the Basal Ganglia

A

Parkinson’s disease (substantia pars compacta)
Huntington’s disease - chorea (caudate)
Hemiballism (subthalamic)
Wilson’s disease (lenticular)

141
Q

What are some clinical features of Parkinson’s disease?

A

TRAP
Tremor at rest
cogwheel Rigidity
Akinesia
Postural instability

142
Q

Describe the pathophysiology of Parkinson’s

A

Degeneration of dopaminergic neurons of substantia pars compacta means lack of inhibition of indirect pathway, and a lack of excitation of direct pathway.

143
Q

What causes Huntington’s disease?

A

Autosomal dom
CAG triple repeat (>40 repeats)

144
Q

What structural changes are associated with Huntington’s disease?

A

Caudate nuc. wasting leading to increase volume of lateral ventricles

145
Q

What pathway is affected in Huntington’s disease and what are the symptoms caused by such?

A

Indirect is affected
Hyperkinesia, dyskinesia
Inappropriate or repetitive movement

146
Q

What is used to treat Huntington’s disease?

A

Dopamine antagonist effective in reducing involuntary movement (Chlorpromazine)

147
Q

What is Wilson’s disease?

A

Autosomal recessive
Abnormal copper accumulation (rings in eyes)

148
Q

What is an example of first line treatment for Parkinson’s?

A

Levodopa
combined with a dopa decarboxylase inhibitor (lowers dose needed and peripheral system side effects such a HT and nausea)

149
Q

What are some long term side effects of Levodopa?

A

Involuntary writhing (dyskinesia) may appear within 2 years on face and limbs
Rapid fluctuations in clinical state (doing well one day, then bad the next)

150
Q

Give examples of Dopamine agonists used in Parkinson’s treatment

A

Ropinirole
Rotigotine (transdermal patch)
Apomorphine (injection)

151
Q

What is the function of MAOI in Parkinson’s disease?

A

Inhibition of MAO-B protects dopamine from extra neuronal degradation therefore increasing conc of Dopamine

152
Q

What antiviral may be used for Parkinson’s?

A

Amantadine

Neuro (14 decks)

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