Neuro 5 Cranium Ventricles Meninges

Front 1

What opening does the middle meningeal a. enter the skull through?

Back 1

foramen spinosum

Front 2

the middle meningeal a. branches off of which artery?

Back 2

external carotid

Front 3

which vessels are found in the subdural space?

Back 3

bridging veins

Front 4

what layers are the dural venous sinuses found within?

Back 4

periosteal and meningeal dura

Front 5

describe the flow of CSF

Back 5

lateral ventricle → foramen of Monro → 3rd ventricle → cerebral aqueduct → 4th ventricle → foramen of Luschka or foramen of Magendie → subarachnoid space → arachnoid granulations → dural venous sinuses

Front 6

where is the 3rd ventricle located?

Back 6

within the thalamus and hypothalamus

Front 7

what forms the roof of the 4th ventricle?

Back 7

cerebellum

Front 8

what forms the floor of the 4th ventricle?

Back 8

pons and medulla

Front 9

vasogenic edema

Back 9

extravasation of fluid into the interstitial space caused by a disruption of the blood-brain barrier

Front 10

what innervates the supratentorial dura?

Back 10

CN V

Front 11

what innervates the dura of the posterior fossa?

Back 11

CN X (also CN IX and C1-C3)

Front 12

mass effect

Back 12

any distortion of brain geometry due to a mass lesion

Front 13

what is the most important indicator of elevated ICP?

Back 13

altered mental status - irritability, depressed level of alertness and attention

Front 14

what part of the brain passes through the tentorial notch in transtentorial herniation?

Back 14

medial temporal lobe, especially the uncus (uncal herniation)

Front 15

what is the clinical triad of uncal herniation?

Back 15

blown pupil, hemiplegia, and coma

Front 16

concussion

Back 16

reversible impairment of neurologic function for minutes to hours following a head injury

Front 17

what are the clinical features of concussion?

Back 17

loss of consciousness, "seeing stars" followed by HA, dizziness, and occasionally nausea and vomiting

Front 18

how can you distinguish an acute subdural hematoma from a chronic subdural hematoma on MRI?

Back 18

acute blood is hyperdense (bright); isodense (1-2 weeks)
chronic is hypodense (3-4 weeks)

Front 19

what are the most common locations for intracranial aneurysms?

Back 19

anterior communicating a.
posterior communicating a.
middle cerebral a.

Front 20

what are the risk factors for aneurysmal rupture?

Back 20

HTN, cigarette smoking, alcohol, sudden increase in BP

Front 21

what are the signs and symptoms of meningeal irritation?

Back 21

HA, lethargy, photophobia, phonophobia, fever, nuchal rigidity

Front 22

Should you perform a CT scan with or w/o contrast if you suspect a hemorrhage?

Back 22

without b/c both the contrast and blood appear white

Front 23

in regards to the CT, when should you perform a lumbar puncture if you suspect a subarachnoid hemorrhage?

Back 23

only when the CT is negative; with a positive CT, increased transmural pressure across the aneurysm can precipitate rebleeding

Front 24

what is the most common cause of intraparenchymal hemorrhage?

Back 24

HTN

Front 25

what is the most common cause of lobar hemorrhage?

Back 25

amyloid angiopathy

Front 26

what is the difference b/w communicating and noncommunicating hydrocephalus?

Back 26

communicating is caused by impaired CSF reabsorption in the arachnoid granulations; noncommunicating is caused by obstruction of flow within the ventricular system

Front 27

what does ventricular dilation in hydrocephalus cause?

Back 27

frontal lobe-like abnormalities including an unsteady magnetic gait and incontinence

Front 28

what is the clinical triad of normal-pressure hydrocephalus?

Back 28

gait difficulties, urinary incontinence, and mental decline; chronically dilated ventricles

Front 29

which tumors are most commonly associated with seizures?

Back 29

oligodendrogliomas and meningiomas

Front 30

what are the most common tumors that metastasize to the brain?

Back 30

lung, breast, skin (melanoma), kidney, GI

Front 31

how does the onset of symptoms differ in meningeal irritation caused by fungal, parasitic, or bacterial infection?

Back 31

gradual (weeks to months) in fungal or parasitic infections; rapid (hours) in bacterial infections

Front 32

describe the composition of CSF in bacterial meningitis

Back 32

high WBC with a PMN predominance, high protein, and low glucose

Front 33

what are the presenting features of epidural abscess?

Back 33

back pain, fever, elevated peripheral WBC count, HA, and signs of nerve root or spinal cord compression

Front 34

subdural empyema

Back 34

collection of pus in the subdural space, usually resulting from direct extension from an infection of the nasal sinuses or inner ear

Front 35

what is the most common cause of lymphocyte-predominant meningitis (aseptic meningitis)?

Back 35

virus

Front 36

describe the CSF in viral meningitis

Back 36

elevated WBC count with a lymphocytic predominance, normal or mildly elevated protein, and normal glucose

Front 37

what is the most common cause of viral encephalitis?

Back 37

herpes simplex virus

Front 38

what are the presenting signs of viral encephalitis?

Back 38

bizarre psychotic behavior, confusion, lethargy, HA, fever, meningeal signs, and seizures

Front 39

what should be done before lumbar puncture?

Back 39

CT scan to check for increased ICP, which can cause herniation

Front 40

how do you know if RBCs in the CSF are from a traumatic tap or subarachnoid hemorrhage?

Back 40

RBCs decrease from the first to last tube in traumatic and centrifugation produces a xanthochromic supernatant if hemorrhage occurred hours before