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101 Cards in this Set
- Front
- Back
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At what level is the cervico-medullary junction?
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foramen magnum, base of the skull
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Border dividing the anterior and middle cranial fossa
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lesser wing of sphenoid
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Border dividing the middle cranial fossa and posterior cranial fossa
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petrous ridge of temporal bone
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3 layers of meningens from outside to inside
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dura, arachnoid, pia
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2 layers of dura
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outer periosteal and inner meningeal
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What is the falx cerebri?
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sheet of dura separating the hemispheres; suspended from roof of cranium
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What is the tentorum cerebelli?
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sheet of dura covering the cerebellum
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What does the midbrain pass through to get from the cerebellum to the cerebrum?
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tentorial notch (incisura)
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CSF is found between what layers of meninges?
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arachnoid and pia (subarachnoid space)
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Between what meningeal layers is the subdural space?
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dura and arachnoid
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Through which foramen does the middle meningeal artery enter the skull?
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spinosum
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A rupture of the middle meningeal artery would lead to a hematoma in what potential space? (epidural, subdural or subarachnoid)
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epidural space
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Middle meningeal artery is a branch off what major artery?
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external carotid
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Middle meningeal artery supplies blood to what?
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meninges
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Middle cerebral artery supplies blood to what?
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cereberum
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Middle cerebral artery is a branch off what major artery?
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internal carotid
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Dural sinuses drain blood through what major sinuses into what major vein?
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sigmoid sinuses into internal jugular vein
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CSF is made by what cells
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choroid plexus
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What are ependymal cells?
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epithelial cells within the ventricles
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The 4th ventricle is surrounded by what structures?
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pons, cerebellum, medulla
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How does CSF travel from lateral ventricles to the 3rd ventricle?
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Foramen of Monro
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How does CSF travel from the 3rd ventricle to the 4th ventricle?
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Aqueduct of Sylvius
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How does CSF travel from the 4th ventricle to the superior sagittal sinus?
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Foramen of Luschka (laterally) and Magendie (medially)
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Where are arachnoid villi located?
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superior sagittal sinus in subarachnoid space
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The 3rd ventricle lies within which brain structures?
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thalamus, hypothalamus
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CSF absorbed by arachnoid villi goes where?
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into the dural sinuses > internal jugular
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What is a cistern?
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local area of CSF collection in the brain
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Largest cistern
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cisterna magna
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The cauda equina is found in which cistern?
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lumbar cistern
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During a spinal tap, which cistern is CSF being taken from?
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lumbar cistern
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What cells are responsible for the blood/CSF barrier?
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choroid epithelium = barrier between capillaries and CSF
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Why is the median eminence lacking a blood-brain barrier?
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it is part of the hypothalamus and needs to sense blood chemistry and hormone levels
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Why is the neurohypophysis lacking a blood-brain barrier?
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it needs to release pituitary hormones into the bloodstream
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Melatonin is released by what gland ...
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pineal
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What is vasogenic edema?
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extracellular fluid due to disrupted blood-brain barrier
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What causes cytotoxic edema?
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infarction = excess intracellular fluid
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A patient has edema with an intact blood-brain barrier. What is this most likely called?
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cytotoxic edema (due to infarction). if the BBB was disrupted then it would be vasogenic
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A patient has a headache in their forehead. Which nerve is sensing the pain most likely?
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the supratentorial dura is innervated by CN V
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A patient has a headache in the back of their head. Which nerves are sensing the pain most likely?
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CN X, IX or C1-C3
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What is fortification scotoma?
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visual loss with zig-zag lines
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What are the different types of headaches?
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migraine (vascular), cluster, complicated (basilar, opthalmologic), tension-type
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What are complicated headaches?
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neurologic deficits lead to headache
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Common causes of migraine headaches?
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inflammation or any other blood vessel changes
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What is the "Mass effect"?
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lesion in one area will compress other structures. improper symmetry brain geometry
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What is the cerebral perfusion pressure?
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BP - intercranial pressure = cerebral perfusion pressure; tells us that increased herniation/cranial pressure = less perfusion
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With small increases in cranial pressure, how would blood pressure auto-regulate to keep cerebral perfusion constant?
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autoregulation would increase the BP. (BP-cranial pressure = cerebral perfusion). with a small increase in cranial pressure, auto-regulation can increase BP enough to compensate
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What might we expect to see with regard to the optic disc if there was acute high intercranial pressure?
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nothing. papilledema is mostly seen with chronic high inter-cranial pressure
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What is Cushing's triad?
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hypertension, bradycardia, irregular respiration; caused by high inter-cranial pressure. BP increases to compensate for cerebral perfusion, bradycardia is reflex to high BP. Compression of pons due to pressure = irregular respirations
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Normal inter-cranial pressure (mmHg)
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<15 mmHg (or < 20 cm H2O)
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What is transtentorial hernitaion?
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increased inter-cranial pressure forces the brain through the tentorium cerebelli. the uncus of the brain is most affected, also called uncal herniation
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A patient presents with a blown pupil, hemiplegia, and coma. What is a common diagnosis?
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uncal herniation; possible due to hematoma
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Why is a blown pupil characteristic of uncal herniation?
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compression of CN3 (occulomotor) in the cerebral peduncles = no CN# parasympathetics = inability to constrict pupils
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Why is hemiplegia characteristic of uncal herniation?
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the inferior herniation compresses the cerebreal peduncles, containing the corticospinal tract
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Why is coma seen in with uncal herniation?
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the inferior herniation compresses the pons and reticular center = poor regulation of alertness/consciousness = coma
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What is the cerebral perfusion pressure?
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BP - intercranial pressure = cerebral perfusion pressure; tells us that increased herniation/cranial pressure = less perfusion
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With small increases in cranial pressure, how would blood pressure auto-regulate to keep cerebral perfusion constant?
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autoregulation would increase the BP. (BP-cranial pressure = cerebral perfusion). with a small increase in cranial pressure, auto-regulation can increase BP enough to compensate
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What might we expect to see with regard to the optic disc if there was acute high intercranial pressure?
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nothing. papilledema is mostly seen with chronic high inter-cranial pressure
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What is Cushing's triad?
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hypertension, bradycardia, irregular respiration; caused by high inter-cranial pressure. BP increases to compensate for cerebral perfusion, bradycardia is reflex to high BP. Compression of pons due to pressure = irregular respirations
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Normal inter-cranial pressure (mmHg)
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<15 mmHg (or < 20 cm H2O)
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What is transtentorial hernitaion?
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increased inter-cranial pressure forces the brain through the tentorium cerebelli. the uncus of the brain is most affected, also called uncal herniation
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A patient presents with a blown pupil, hemiplegia, and coma. What is a common diagnosis?
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uncal herniation; possible due to hematoma
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Why is a blown pupil characteristic of uncal herniation?
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compression of CN3 (occulomotor) in the cerebral peduncles = no CN# parasympathetics = inability to constrict pupils
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Why is hemiplegia characteristic of uncal herniation?
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the inferior herniation compresses the cerebreal peduncles, containing the corticospinal tract
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Why is coma seen in with uncal herniation?
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the inferior herniation compresses the pons and reticular center = poor regulation of alertness/consciousness = coma
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Which is worse, central herniation or uncal herniation?
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central herniation; uncal is usually unilateraly, central herniation leads to bilateral uncal herniation
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What is tonsillar herniation?
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cerebral tonsils slip through foramen mangum = medulla compression = very fatal
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What is a subfalcine herniation?
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mass of pressure pushes brain to one hemisphere. less pressure on brainstem than other herniations
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A subfalcine herniation is most likely to lead to infarcts in areas supplied by which artery?
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anterior cerebral artery can be compressed by subfalcine herniation
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A patient with head trauma suffers from reversible neurological deficit for a few hours. What was the diagnosis?
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concussion
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A patient suffers from head trauma and the temporal bone is fractured. Where might we suspect a hematoma?
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temporal bone fracture = middle meningeal artery lesion likely = epidural hematoma
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A patient is seen to have a lens shaped hemorrhage on CT. Where is blood collecting?
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epidural hematoma
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A patient is seen to have a crescent shaped hemorrhage on brain CT. Where is blood collecting?
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subdural hematoma
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Rupture of what blood vessels could lead to subdural hematoma?
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bridging vessels moving blood between the subarachnoid vessels to the epidural vessels
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What is worse, chronic or acute subdural hematoma?
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acute. chronic gives the patients time to adjust
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A patient with aneurysm of a surface blood vessel will likely have what type of hematoma?
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subarachnoid space contains most surface blood vessels
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Which aneurysm is more likely to rupture, fusiform os saccular?
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saccular
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How do we treat cerebral vasospasm after subarachnoid hemorrhage?
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Triple H therapy = induce hypertension, hypervolemia, hemodilution
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What is the most common cause of non-traumatic subarachnoid hematomas?
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aneurysms
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What is coup injury?
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contusions occur on same side of injury
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Most common location for hypertensive hemorrhage (atraumatic intra-cerebral hemorrhage) in brain?
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basal ganglia
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What are arteriovenous malformations?
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direct connections between arteries and veins,
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3 major causes of hydrocephalus
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excess CSF production; obstruction of CSF drainage; decreased absorption of CSF
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What is a communicating hydrocephalus?
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poor CSF reabsorption or excess production
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What is a non-communicating hydrocephalus?
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obstruction = CSF collection = hydrocephalus
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With hydrocephalus, what is the first cranial nerve to be affected?
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CN 6 (in the cavernous sinus)
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What is Parinaud's syndrome?
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oversized 3rd ventricle compresses colliculi and midbrain
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A patient presents with gait difficulty, urinary incontinence, and mental decline. What type of hydrocephalus do they have?
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normal pressure hydrocephalus
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In adults, most tumors are (supratentorial or infratentorial)?
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supratentoirial
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In children, most tumors are (supratentorial or infratentorial)?
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infratentorial
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Schwannomas are typically seen affiliated with which cranial nerve?
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CN 8 (vestibulocochlear)
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Why do pineal tumors cause hydrocephalus?
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obstruction of aqueduct of Sylvius (between 3rd and 4th ventricle)
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What is meningitis?
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infection of the CSF in subarachnoid space
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CSF with a higher levels of lymphocytes than leukocytes suggests what diagnosis?
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viral meningitis
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How does ESR (erythrocyte sedimentation rate) change in a patient with bacterial meningitis?
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ESR increases with inflammation
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What is subdural empyema?
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pus in the subdural space from nasal sinus or ear infection
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Infections caused by spirochetes
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neurosyphillis and Lyme disease
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What is aseptic meningitis?
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meningitis that is not bacterial in origin
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Most common cause of viral encephalitis?
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Herpes I (HSV1)
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What is toxoplasmosis?
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parasitic infection of nervous system; seen with HIV
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What is a prion?
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a protein-based infectious agent seen with mad cow disease; no DNA/RNA
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Lumbar puncture is commonly done between which vertebrae?
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L4/L5
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