Scalp, Meninges & Dural Venous Sinuses

Front 1

What are the three parts of the flat compact bones which compose the neurocranium?

Back 1

External table
Diploe
Internal table

Front 2

What is another name for the braincase?

Back 2

Neurocranium

Front 3

What is the name for immobile fibrous joints in the braincase?

Back 3

sutures

Front 4

What is the name for the space that houses the brain, meninges, blood vessels and intracranial portions of cranial nerves?

Back 4

Cranial cavity

Front 5

What supplies the blood for the cranial cavity?

Back 5

The meningeal arteries

Front 6

What are the four bones which compose the pterion?

Back 6

Frontal, parietal, temporal and sphenoid bones

Front 7

Why is the pterion an important clinical landmark?

Back 7

It overlies the anterior branch of the middle meningeal artery.

Front 8

What can result from a skull fracture at the pterion which ruptures the anterior branch of the middle meningeal artery?

Back 8

An Epidural hematoma

Front 9

What are the membraneous intervals which result from the bones of the calvaria being incompletely ossified.

Back 9

Fontanelles

Front 10

What are two important clinical applications for fontanelles?

Back 10

The infant brain can be imaged by ultrasound through the fontanelles

Bulging of the fontanelles indicates elevated intracranial pressure.

Front 11

What is the term for: "The skin and subcutaneous tissue covering the top of the head?

Back 11

The Scalp

Front 12

Define the extent of the scalp.

Back 12

From the superior margins of the orbits anteriorly to the superior nucal line posteriorly;
Laterally to the zygomatic arches

Front 13

What are the five layers of the scalp?

Back 13

Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium

Front 14

Which three layers of the scalp are firmly attached and move as a unit?

Back 14

The SCA part of the S.C.A.L.P.
Skin
Connective tissue
Aponeurosis

Front 15

Why do the first three layers of the scalp move together as a unit?

Back 15

Collagenous septa

Front 16

What are sebaceous cysts?

Back 16

Cysts caused by obstruction of the sebacous gland ducts. they remain in and move with the skin.

Front 17

Which layer of the scalp contains the blood vessels and nerves of the scalp?

Back 17

The connective tissue layer

Front 18

Why do superficial scalp wounds bleed profusely?

Back 18

Fibrous septa attach to the outer walls of the arteries that course in this layer and preven their retratction following laceration.

Front 19

What is the aponeurotic layer?

Back 19

A fibro-muscular sheet extending from the occiput to the eyebrows; attaches to the zygomatic arch laterally.

Front 20

What are the two components (really three) components of the aponeurotic layer?

Back 20

The epicranial aponeurosis
Frontalis muscle
Occipitalis muscle

Front 21

What is the origin of the frontalis muscle?

Back 21

The anterior border of the aponeurosis

Front 22

What is the insertion of the forntalis muscle?

Back 22

Skin & subcutaneious tissue of eyebrows

Front 23

What is the action of the frontalis muscle?

Back 23

Raises eyebrows and wrinkles forehead.

Front 24

What is the innervation ofthe frontalis muscle?

Back 24

Facial nerve (CN VII)

Front 25

What is the origin of the occipitalis muscle?

Back 25

Superior nuchal line (occipital bone) & Mastoid Temporal Bone

Front 26

What is the insertion of the occipitalis?

Back 26

Posterior border of aponeurosis.

Front 27

What is the action of the occipitalis?

Back 27

Pulls scalp posteriorly.

Front 28

What is the innervation of the occipitalis?

Back 28

Facial nerve (CN VII)

Front 29

Why do deep scalp wounds gape widely if the aponeurosis is severed in a coronal plane?

Back 29

The aponeurotic frontalis and occipitalis muscles pull the fibers of the aponeurosis in opposite directions.

Front 30

What is the function of the loose (areolar connective tissue)?

Back 30

allows the first three layers to slide freely over the skull

Front 31

What area is known as the "danger area" of the scalp?

Back 31

The loos connective tissue.

Front 32

How would infections spread into the cranial cavity from the loose (areolar) connective tissue layer?

Back 32

Via emissary veins which pass trhough foramina in the skull to communicat with the dural venous sinuses.

Front 33

What is the pericranium.

Back 33

The periosteum of the external surface of the skull bones.

Front 34

What is a benign complication of birth injury to the skull in which the bledding occurs between the pericranium and the underlying skull bone?

Back 34

A cephalohematoma

Front 35

Does a cephalohematoma appear red?

Back 35

No

Front 36

Name the five arteries from anteriormedio to posterior medio that supply the scalp.

Back 36

Supratrochlear
Supraorbital
Superficial temporal
Posterior auricular
Occipital

Front 37

Are the arteries heavily anastomised?

Back 37

Yes

Front 38

Which two arteries arise from the opthalmic artery (which goes through the superior orbital fissue) which itself arises from the Internal Carotid Artery?

Back 38

Supraorbital
Supratrochlear

Front 39

Which three scalp arteries arise from the external carotid artery (directly)

Back 39

Superficial temporal
Posterior Auricular
Occipital

Front 40

Which artery exits the orbit via the supraorbital foramen and passes superiorly in the scalp, Lateral to the supratrochlear artery

Back 40

Supraorbital artery

Front 41

Whcih artery exits the upper medial corner of orbit; ascends medial to supraorbital artery?

Back 41

Supratrochlear artery

Front 42

Which artery ascends anterior to the ear; located anteiro to auirculotemporal nerve?

Back 42

Superficial temporal artery

Front 43

Which artery ascends posterior to the ear?

Back 43

Posterior Auricular artery

Front 44

Which artery enters scalp posteriorly; terminal part accompanies greater occipital nerve in scalp?

Back 44

Occipital artery

Front 45

What innervates (sensory) the scalp anterior to the ear?

Back 45

Branches of all three divisions of the trigeminal nerve (CN V)

Front 46

What innervates (sensory) posterior to the ear?

Back 46

Branches of spinal nerves (C2&C3)

Front 47

What two nerves originate from the Ophtahlmic Division of Trigeminal Nerve (CN V)?

Back 47

Supraorbital nerve
Supratrochlear nerve

Front 48

What nerves course with arteries of the same name?

Back 48

Supraorbital nerve and Supratrochlear nerve

Front 49

What two nerves distribute on the front of the scalp?

Back 49

Supraorbital nerve
Supratrochlear nerve

Front 50

What is the origin of the Zygomaticotemporal?

Back 50

Maxillary Division of Trigeminal Nerve (CN V2)

Front 51

What nerve passes superiorly from lateral wall of orbit?

Back 51

Zygomaticotemporal nerve

Front 52

What nerve distributes on the anterior temple region?

Back 52

Zygomaticotemporal nerve

Front 53

What is the origin of the auriculotemporal nerve?

Back 53

The Mandibular Division of Trigeminal Nerve (CN V3)

Front 54

What nerve asscends in front of ear; located posterior to superficial temporal artery?

Back 54

Auriculotemporal nerve

Front 55

Which nerve innervates the posterior temple region?

Back 55

Auriculotemporal nerve

Front 56

What nerve originates off of the C2 & C3 (via cervical plexus)?

Back 56

Lesser Occipital Nerve

Front 57

What nerve originates off of the C2 (Dorsal Ramus)?

Back 57

Greater Occipital nerve

Front 58

What nerve ascends posterior to ear?

Back 58

Lesser Occipital nerve

Front 59

What nerve innervates behind the area behind & above ear?

Back 59

Lesser occipital nerve

Front 60

What nerve pierces trapezius; accompanies occipital artery in scalp?

Back 60

Greater Occipital

Front 61

What nerve innervates (sensory) the scalp of back of head?

Back 61

Greater Occipital

Front 62

What are the three connective tissue membrans from external to internal?

Back 62

Dura Mater
Arachnoid Mater
Pia Mater

Front 63

What is the outer layer of the dura mater called?

Back 63

Periosteal Dura

Front 64

What is the inner layer of the dura mater called?

Back 64

Meningeal Dura

Front 65

What is another name for the periosteum of the inner surface of the skull bones?

Back 65

Periosteal dura

Front 66

What separates to form specialized structures called dural partitions and dural venous sinuses?

Back 66

The meningeal dura

Front 67

Which dural layer is continous through the foramen magnum with the dura mater coveirng the spinal cord.
Forms sheaths fro cranial nerves as they exit the cranial cavity.

Back 67

The Meningeal Dura

Front 68

Adheres to the inner surface of the skull bones with tightest attachment at the sturue lines and the cranial base
Is continuous with the periosteum of the external table of skull bones at cranial foramina?

Back 68

The Periosteal Dura

Front 69

What is the arterial supply to the dura mater?

Back 69

The meningeal arteries

Front 70

Which is the largest meningeal artery?

Back 70

The middle (Recall that the Anterior is the one lying below the pterion).

Front 71

What is the main sensory innervation of the dura?

Back 71

The three divisions of the the trigeminal nerve (CN V)

Front 72

What are the two important potential spaces within the cranial cavity?

Back 72

Epidural space
Subdural space

Front 73

Through which potential space does the middle meningeal artery course?

Back 73

Epidural space

Front 74

What is the cause for an epidural hematoma?

Back 74

A tearing of the middle meningeal artery or its branches usually from head trauma causes hihg-pressure bledding into the epidural space

Front 75

What is the typical clinical course of an epidural hematoma?

Back 75

Temporary loss of consciousness
A brief lucid period (hours)
Drowsiness & coma; often accompanied by motor paralysis on the contralateral side of the body

Front 76

Which space is the potential space between the meningeal dura and the underlying arachnoid mater?

Back 76

Subdural space

Front 77

Through which potential space do cerebral veins cross?

Back 77

Subdural space

Front 78

What does tearing of cerebral veins cause?

Back 78

A slowly expanding low pressure bleeding called a subdural hematoma

Front 79

What is the clinical course for the expression of symptoms in the case of a subdural hematoma?

Back 79

Very slow (weeks) before neurological symptoms develop.

Front 80

What is the delicate avascular membran located internal to the meningeal dura layer?

Back 80

The Arachnoid mater

Front 81

What covers the brain's surface loosely without entering the sulci or fissures?

Back 81

The Arachnoid mater

Front 82

What is separated from the underlying pia mater by the subarachnoid space?

Back 82

The ARachnoid mater

Front 83

What extends across the subarachnoid space and contacts the pia mater from the arachnoid mater?

Back 83

Arachnoid trabeculae

Front 84

Is the Subarachnoid a true or a false space between the arachnoid mater and pia mater?

Back 84

A True space

Front 85

What fills the subarachnoid space?

Back 85

CSF

Front 86

Where do cerebral arteries and veins (in addition to the subdural potential space) course?

Back 86

In the Subarachnoid space (SAS)

Front 87

What term is given to bleeding into the SAS (most often due to rupture of an aneurysm of a cerebral artery)?

Back 87

Subarachnoid hematoma

Front 88

What is the clinical manifestation of a subarachnoid hematoma?

Back 88

A sudden excruciating headache
Lumbar Punctures are positive for blood
CT scan reveal blood following the contours of the brain within the SAS

Front 89

What is the thin hihgly vascularized membrane adherent to the surface of the brain which follows its contours?

Back 89

Pia mater

Front 90

Name the four dural partitions

Back 90

Falx Cerebri
Tentorium Cerebelli
Falx Cerebelli
Diaphragma Sella

Front 91

Name the dural partition which is sickle shape, vertical partition suspended from the roof of the cranial cavity in the midline which attaches anteriorly to protrusions on the frontal an dethmoid bones, and posteriorly to the tentorium cerebelli. Lies in the longitudinal fissure.

Back 91

Falx cerebri

Front 92

Which dural partition is described as a horizontal (actually tent-shaped) partition that forms an incomplete roof over the posterior cranial fossa? It divides the cranial cavity into a suprtentorial compartment and an infratentorial compartment.

Back 92

Tentorium Cerebelli

Front 93

What components of the brain are located in the supratentorial compartment?

Back 93

The Telencephalon
The Diencephalon

Front 94

What components of the brain are located in the infratentorial compartment?

Back 94

The Brainstem
Cerebellum

Front 95

Describe the attachments of the fixed outer border.

Back 95

Attaches to the posterior clinoid processes of the sphenoid bone, the upper borders of the petrous temporal bones and the edges of the grooves for the transverse sinuses

Front 96

Describe the attachments for the free inner border of the tentorium cerebelli.

Back 96

Crosses the fixed boerder anteriorly to attach to the anterior clinoid processes of the sphenoid bone.

Front 97

What is the term for the curved gap between the free border fo the tentorium cerebelli and the sphenoid bone?

Back 97

The tentorial notch

Front 98

What passes through the tentorial notch?

Back 98

The Brainstem

Front 99

Describe a tentorial herniation.

Back 99

Increased pressure in the supratentorial compartment, due to tumor, stroke, hydrocephalus, etc. causes part of the temporal lobe (the uncus) mto move downward through the tnetorial notch. The displaced uncus can compress the midbrain and/or the cranial nerves and blood vessesl on the ventral surface of the midbrain.

Front 100

What dural partition is a small vertical partition that partially separates the left and right cerebellar hemispheres?

Back 100

Falx Cerebelli

Front 101

Describe the attachments of the Falx Cerebelli.

Back 101

Attaches to the internal occipital crest of the occipital bone and the lower surface of the tentorium cerebelli. Its anterior border is free

Front 102

Which dural partition is a circular, horizontal partition forming a roof over the hypohphyseal fossa of the sphenoid bone where the pituitary gland is housed?

Back 102

Diaphrgama Sellae

Front 103

What dural paritition has a central aperture for passage of the infundibulum (pituitary stalk)?

Back 103

Diaphragma Sellae

Front 104

What lines the Dural venous sinuses?

Back 104

Endothelium

Front 105

Where are many dural venous sinuses located (the fixed or free borders) of a dural partition?

Back 105

The fixed borders

Front 106

List the four types of venous drainage for the dural venous sinuses.

Back 106

Cerebral veins
Meningeal veins
Diploe Veins
Emmisary veins

Front 107

Name this type of vein, drains the cerebral hemispheres and the upper brainstem

Back 107

Cerebral veins

Front 108

Name this type of vein: Drains the meninges

Back 108

Meningeal veins

Front 109

Name this type of vein:
Drain the cranial bones

Back 109

Diploic veins

Front 110

Name this type of vein:
Connects the veins of the face and scalp to dural venous sinuses by passing through foramina in the cranial bones.

Back 110

Emmisary veins

Front 111

What mediates CSF resorption?

Back 111

Arachnoid villi

Front 112

Whar are large collections of arachnoid villi which form tuft-like structures?

Back 112

Arachnoid granulations

Front 113

Where do Dural venous sinuses eventually drain to?

Back 113

Directly or indirectly to the internal jugula vein

Front 114

What is the largest dural venous sinus, located in the convex attached border of the falx cerebri?

Back 114

Superior Sagittal sinus

Front 115

Where does the superior Sagittal sinus begin?

Back 115

At the attachment of the falx cerebri to the crista galli of the ethmoid bone

Front 116

Where does the superior sagittal sines end?

Back 116

Ends by joining one of the transvers sinuses (usually the right)

Front 117

What is the dilated region where the superio sagittal sinus meets the transverse sinus?

Back 117

Confluence of sinues

Front 118

Where does the conflunece of sinuses usually occur?

Back 118

On one side of the internal occipital protuberance (usually on the right side)

Front 119

What are prominent later expansions of the superior sagittal sinus called?

Back 119

Venous lacunae

Front 120

Where are arachnoid granulations most numerous?

Back 120

In the Superior Sagittal sinus

Front 121

Where is the inferior sagittal sinus located?

Back 121

Located between the two opposed layers of meningal dura in the free (inferior ) border of the falx cerebri

Front 122

Where does the inferior sagittal sinus drain?

Back 122

Into the straight sinus

Front 123

What is formed by the union of the interior sagittal sinus with the great cerebral vein (great vein of Galen)?

Back 123

The Straight sinus

Front 124

What lies in the attachment of the falx cerebri to the upper surface of the tentorium cerebelli?

Back 124

The Straight sinus

Front 125

Which sinus usually joins the left transverse sinus?

Back 125

Straight sinus

Front 126

What sinus is located in the fixed border of the falx cerebelli?

Back 126

Occipital sinus

Front 127

Where does the occipital sinus end?

Back 127

At the confluence of sinuses

Front 128

What sinuses run laterally from the internal occipital protuerance in the posterolateral fixed border of the tentorium cerebelli?

Back 128

The transverse sinuses

Front 129

What forms deep groves in the occipit and parietal bones?

Back 129

Transverse sinuses

Front 130

Which sinuses becomes the sigmoid sinueses just behind the posterolateral border of the posterolateral border of the petrous temporal bone?

Back 130

Transverse sinuses

Front 131

Which sinuses enter the jugular foramen and empty into the jugular bulbs?

Back 131

Sigmoid sinuses

Front 132

Which sinuses are located on either side of the body of the sphenoid bone?

Back 132

Cavernous sinuses

Front 133

What are the important structures located in the cavernous sinuses?

Back 133

Internal Carotid Artery (ICA)
Abducens nerve (CN VI)

Note ICA is medial to CN VI

Front 134

What structures are located on the walls from superior to inferior?

Back 134

CN III
CN IV
V1 (Opthalmic div Trigeminal)
V2 (Maxillary div Trigeminal)

Front 135

What drains into the cavernous sinuses?

Back 135

the ophthalmic veins
the sphenoparietal sinuses

Front 136

What is the clinical application of the cavernous sinuses?

Back 136

An infection in the face can easily reach the cavernous sinus, since the sinus is connected to the facial vein via the superior ophthalmic vein. The resulting thrombomphlebitis of the cavernous sinus can affect the cranil nerves coursing in the sinus or its walls

Front 137

Where does the cavernous sinus drain into?

Back 137

The superior and inferior petrosal sinuses

Front 138

Where is the Superior Petrosal sinuses located?

Back 138

Anterolateral fixed border of the tentorium cerebelli

Front 139

What does the superior petrosal sinuses connect?

Back 139

The posterior ends of the cavernous sinuses to the anterior ends of the transverse sinuses

Front 140

What sinus starts at the posteroinferior ends of the cavernous sinuses and courses in grooves between petrous temporal bones and the basilar part of the occipital bone?

Back 140

The inferior petrosal sinuses

Front 141

What sinus enters the anterior part of the jugular foramen?

Back 141

Inferior petrosal sinuses

Front 142

What drains directly into the jugular bulbs?

Back 142

The Inferior petrosal sinuses and the sigmoid sinuses (are there more?)

Front 143

What sinus is a collection of venous channels lying between the periosteal and meningeal dura layers over the clivus which interconnects the left & right inferior petrosal sinuses

Back 143

The Basilar Sinus (Plexus)