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75 Cards in this Set

  • Front
  • Back

the anterior fossa contains what parts of the brain?

frontal lobes
the middle fossa contains what parts of the brain?
temporal lobes
the posterior fossa contains what parts of the brain?
cerebellum, brainstem
what divides the anterior and middle fossae?
lesser wing of sphenoid
what divides middle fossa from posterior fossa?
petrous ridge of temporal bone and tentorium cerebelli
what two places is the periosteal dura separated from the meningeal dura?
falx cerebri and tentorium cerebelli
what structure normally passes through the tentorial notch?
midbrain
waht is the Virchow-Robin space?
where the pia surrounds and is fused to the initial portion of blood vessels as they come out of the brain tissue
what structure traverses the skull via the foramen spinosum?
middle meningeal artery
difference between middle meningeal artery and middle cerebral artery?
mid meningeal is from ext carotid, supplies dura

mid cerebral is from int carotid, supplies brain
main route of flow of dural venous sinuses?
drain to sigmoid sinuses then to int jugular vv.
the major arteries of the brain travel within what space?
subarachnoid
the spinal cord is enveloped by the same meninges as the brain, but is also surrounded by what?
epidural fat
what surrounds the third ventricle?

fourth ventricle?
diencephalon

pons, medulla, cerebellum
flow of CSF?
lateral ventricles > foramen of Monro > 3rd > aqueduct of Sylvius > 4th > foramina of Luschka & Magendie > spinal cord & brain (subarachnoid space) > arachnoid granulations > dural sinuses > bloodstream
drainage pathways of cavernous sinuses?
sup petrosal sinus to sigmoid sinus to int jugular v
or
inf petrosal sinus directly into int jugular v
what drains into the confluence of sinuses?

to what does it drain?
straight sinus (drains inf sagittal sinus & great cerebral vein of Galen) and sup sagittal sinus

drains to trasnverse sinus into sigmoid sinus into int jugular v
what property gives the BBB its filtering power?
zonula occludens (tight junctions) between capillary endothelial cells
circumventricular organs of the brain (3)
median eminence and neurohypophysis, and area postrema
fortification scotoma is a preceding sx of what?
migraine HA
extremely severe, boring type of HA seen more commonly in males, may happen several times a day for weeks then remit for several months
Cluster HA
type of HA that responds well to O2
cluster HA
cluster HA is often accompanied by what other sxs?
U/L autonomic sxs (tearing, eye redness, Horner's syndrome, flushing, sweating, nasal congestion
mild-moderate, band-like HAs that may occur transiently or continuously for years
tension type hA
first step in eval of pt w/ sudden explosive onset of severe HA?
Head CT to check for subarachnoid hemorrhage
cause of HA that is worse when standing than when lying down?

worse when lying down than standing?
low CSF pressure

neoplasm causing inc ICP
idiopathic HA and inc ICP w/o mass lesion in adolescent females?

TxOC?
pseudotumor cerebri

acetazolamide or shunt
what diagnostic tests should be done early in tx of HA in elderly pt?
ESR and temporal artery bx
hypertension, bradycardia, and irreg respirations may indicate what?
increased ICP
(Cushing's triad)
most important indicator of elevated ICP?
irritability, depressed alertness and attention
HA d/t intracranial mass is often worse at what time of day?
Morning (brain edema increases overnight)
never do a lumbar puncture on a pt w _____
elevated ICP
blown pupil, hemiplegia, and coma signify what?
uncal (tentorial) herniation
in uncal herniation, the condition producing a dilated pupil C/L to the lesion
Kernohan's phenomenon
(midbrain pushed against opposite side of tentorial notch)
MCC of central herniation
any lesion producing diffuse elevated ICP
most common sx of mild central herniation?
lateral rectus (abducens) palsy
subfalcine herniation is usually asxs, but sometimes can cause what?
occlusion of ACAs and anterior cerebral infarct
pt who is seeing stars, followed by HA, dizziness and sometimes N/V may have what?
concussion
rapidly expanding hemorrhage forming lens-shaped pattern on CT, may have lucid interval
epidural hematoma (middle meningeal a)
brain hemorrhage not associated with trauma, w/ vague sxs like HA, cog impairment, unsteady gait, crescent shape on CT
chronic subdural hematoma
brain hemorrhage associated with subarachnoid hemorrhage and contusion, crescent shape on CT?
acute subdural hematoma
MCC of nontraumatic subarachnoid hemorrhage
ruptured arterial aneurysm
risk factors for spontaneous subarach hemorrhage?
atherosclerosis, PCKD, Marfan's (aneurysm risk)

HTN, smoking, etOH, transient high elevations in BP (aneurysmal rupture risks)
what complication is common in survivors of subarachnoid hemorrhage?
delayed cerebral vasospasm (1 wk after), can lead to cerebral ischemia or infarction
MCC of lobar hemorrhage?
amyloid angiopathy
MCC nontraumatic intraparenchymal hemorrhage?
HTN

causes lipohyalinosis and Charcot-Bouchard microaneurysms of small penetrating blood vessels
most common locations of hypertensive hemorrhage?
basal ganglia (putamen), thalamus, cerebellum, pons
severe or rapidly developing cases of hydrocephalus produce what syndrome?
Parinaud's syndrome

(setting sun sign - eyes deviate down and in d/t dilated 3rd ventricle pushing down on colliculus of midbrain)
elderly pt w/ gait difficulties, urinary incontinence, and mental decline may have what?
normal pressure hydrocephalus
two most common primary brain tumors?
glioblastoma, meningioma
in adults, ___ % of brain tumors are supratentorial
70
most common brain tumors in children? (3)
astrocytoma, medulloblastoma, ependymoma
d/t the common placement, brain tumors in children tend to cause what?
hydrocephalus
(usually in posterior fossa)
from what do meningiomas arise?

where do they form most commonly?
arachnoid villus cells

over lateral convexities, in the falx, and along basal regions of cranium
common brain tumor in children that can often be cured by surgical resection?
cerebellar astrocytoma
in women, meningiomas are associated with what?
breast cancer
CSF: high WBCs, high protein, low glucose
Acute bact meningitis (mostly PMNs)

Tuberculous or cryptococcal meningitis (mostly lymphocytes)
CSF: normal to incr WBCs (lymphocytes), high protein, normal glucose
viral (aseptic) meningitis,
herpes meningoencephalitis
common organisms in brain abscess?
Strep, Bacteroides, Enterobacteriaciae, S. aureus, Nocardia
TxOC for brain abscess smaller than 2.5cm?
Ceftriaxone + metro
what are common causes of meningitis in infants 0-3 mo?
E. coli, Group B Strep and Listeria
common causes of meningitis in children 1 mo - 7 yrs?
H. influenzae, N. meningitidis, and S. pneumoniae
what pathogens cause meningitis in ages 7-adult?
Listeria, N. meningitidis, S. pneumoniae
common cause of subdural empyema?
direct extension from infxn of sinuses or inner ear
aseptic meningitis w/ CN palsies, progresses to med-vessel arteritis and diffuse white matter infarcts, ends in general paresis, dementia, UMN-type weakness, and optic atrophy
Neurosyphilis
TxOC for neurosyphilis?
IV pen G
FTA-ABS or MHA-TP test for what?
treponemal antibodies (neurosyphilis)
IC pt presents with seizures, HA, fever, lymphocytic predominant meningitis; brain MRI shows nonenhancing nodules surrounded by a ring of enhancement. Dx?
Toxoplasmosis
TxOC for toxo?
pyrimethamine and sulfadiazine
MCCs of intracranial mass lesions in HIV pts? (2)
Toxo, primary CNS lymphoma
Dx: seizures, hydrocephalus, soft tissue cysts or calcifications (muscle, eye, CNS)
cyticercosis (taenia solium)
Dx: diabetic pt w/ ophthalmoplegia, facial numbness and weakness, visual loss, violet discoloration of tips of eyelids
mucormycosis
Dx: rapid onset dementia, exaggerated startle response, myoclonus, visual distortions, ataxia, periodic sharp waves on EEG
Creutzfield-Jakob dz
lumbar puncture needle is inserted where?
between L4 - L5
(to avoid SC which goes down to L2; post iliac crest is landmark)
Dx: immunologic testing of CSF shows oligoclonal bands
multiple sclerosis