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Questions and Answers

The dura mater is a single-layered structure.

False (B)

Which of the following dural reflections separates the right and left cerebral hemispheres?

  • Diaphragma sellae
  • Falx cerebri (correct)
  • Tentorium cerebelli
  • Falx cerebelli

Which cranial nerve innervates the dura mater of the posterior cranial fossa?

  • Hypoglossal nerve (CN XII)
  • Facial nerve (CN VII)
  • Trigeminal nerve (CN V)
  • Vagus nerve (CN X) (correct)

What is the space between the arachnoid mater and pia mater called?

<p>subarachnoid space</p> Signup and view all the answers

Which of the following structures anchors the spinal cord within the subarachnoid space?

<p>Denticulate ligaments (B)</p> Signup and view all the answers

An epidural hematoma typically extends beyond the suture lines of the skull.

<p>False (B)</p> Signup and view all the answers

Which type of hematoma is characterized by a crescent-shaped appearance on neuroimaging and can cross suture lines?

<p>Subdural hematoma (B)</p> Signup and view all the answers

A subarachnoid hemorrhage is most commonly caused by the rupture of a cerebral ______.

<p>aneurysm</p> Signup and view all the answers

During a lumbar puncture, which interspace is typically used for needle insertion?

<p>L3-L4 or L4-5 (A)</p> Signup and view all the answers

Meningiomas are typically malignant and fast-growing tumors.

<p>False (B)</p> Signup and view all the answers

Which of the following is the most common location for meningiomas?

<p>Parasagittal (A)</p> Signup and view all the answers

What is the largest of the four interconnected cavities within the brain?

<p>lateral ventricles</p> Signup and view all the answers

Which structure connects the lateral ventricles to the third ventricle?

<p>Interventricular foramina (A)</p> Signup and view all the answers

The cerebral aqueduct is the least common site of stenosis within the ventricular system.

<p>False (B)</p> Signup and view all the answers

The fourth ventricle drains into the subarachnoid space via which foramina?

<p>Foramina of Luschka and Magendie (C)</p> Signup and view all the answers

Cerebrospinal fluid (CSF) is produced by the ______ in the ventricles.

<p>choroid plexuses</p> Signup and view all the answers

Which of the following is the largest of the basal cisterns and located posterior to the medulla?

<p>Cisterna magna (B)</p> Signup and view all the answers

Subarachnoid cisterns are devoid of arteries and veins.

<p>False (B)</p> Signup and view all the answers

The median and lateral apertures drain CSF into which cistern?

<p>Cisterna magna (C)</p> Signup and view all the answers

Match the following cerebral arteries with the brain regions they primarily supply:

<p>Anterior Cerebral Artery (ACA) = Medial surface of the frontal lobe and paracentral lobule Middle Cerebral Artery (MCA) = Lateral surface of the cerebral hemispheres, including Broca's and Wernicke's areas Posterior Cerebral Artery (PCA) = Occipital lobe and visual cortex</p> Signup and view all the answers

What are the venous channels located between layers of dura mater called?

<p>Dural venous sinuses (D)</p> Signup and view all the answers

Dural venous sinuses contain valves and muscular walls.

<p>False (B)</p> Signup and view all the answers

Which vein is formed by the union of internal cerebral veins and drains into the straight sinus?

<p>Great cerebral vein of Galen (C)</p> Signup and view all the answers

Name one structure contained in the cavernous sinus

<p>internal carotid artery</p> Signup and view all the answers

Which sinus directly receives blood from the superior sagittal sinus and the straight sinus?

<p>Confluence of sinuses (C)</p> Signup and view all the answers

Cerebral veins eventually drain into the dural venous sinuses, which then drain into the ______.

<p>internal jugular vein</p> Signup and view all the answers

Which of the following accurately describes a lacunar stroke?

<p>Associated with hypertension and small vessel disease (B)</p> Signup and view all the answers

The goal of treatment for ischemic stroke is to decrease perfusion to the penumbra.

<p>False (B)</p> Signup and view all the answers

What is the most common cause of subarachnoid hemorrhage (SAH)?

<p>Ruptured saccular aneurysm (B)</p> Signup and view all the answers

A classic symptom of subarachnoid hemorrhage (SAH) is a sudden, severe headache described as a ______ headache.

<p>thunderclap</p> Signup and view all the answers

Match each type of intracranial hemorrhage with its typical location or associated vessel:

<p>Epidural hematoma = Middle meningeal artery Subdural hematoma = Bridging veins Subarachnoid hemorrhage = Ruptured aneurysm Intracerebral hemorrhage = Basal ganglia (often from hypertension)</p> Signup and view all the answers

Which of the following is a classic symptom triad of increased intracranial pressure (ICP)?

<p>Hypertension, bradycardia, irregular respirations (D)</p> Signup and view all the answers

Sulci effacement on imaging suggests decreased intracranial pressure (ICP).

<p>False (B)</p> Signup and view all the answers

What is the likely cause given: 'Weber syndrome' = midbrain + one-sided CN III palsy + contralateral hemiparesis?

<p>Damage in midbrain affecting CN III (A)</p> Signup and view all the answers

Why does arterial plaques/damage, more often than venous, cause strokes?

<p>arteries provide blood to the brain, veins return it.</p> Signup and view all the answers

Having increased pressure inside head will increase cerebral blood flow.

<p>False (B)</p> Signup and view all the answers

Which type of stroke is known for a watershed distribution causing proximal upper and lower extremity weakness?

<p>Watershed stroke (D)</p> Signup and view all the answers

One way to test to help identify the cardiac source of an embolism is a ______ echos.

<p>transesophageal</p> Signup and view all the answers

Which type of stroke is most commonly known for an elderly hypertension patient, suffering a small vessel disease?

<p>Lacunar (C)</p> Signup and view all the answers

Which of the following is another name for the outermost bilaminar layer of the meninges?

<p>Ectomeninx/pachymeninx (B)</p> Signup and view all the answers

The periosteal layer of the dura mater is avascular and not innervated.

<p>False (B)</p> Signup and view all the answers

What structure do the layers of the dura mater form where they separate and descend into the cranial cavity?

<p>dural reflections</p> Signup and view all the answers

Which dural reflection is the largest and separates the right and left cerebral hemispheres?

<p>Falx cerebri (D)</p> Signup and view all the answers

The tentorial branch of V1 innervates the tentorium cerebelli and the posterior third of the ______.

<p>falx cerebri</p> Signup and view all the answers

Which of the following cranial fossae is innervated by all three trigeminal branches?

<p>Anterior cranial fossa (A)</p> Signup and view all the answers

The arachnoid mater is composed of dense, irregular connective tissue.

<p>False (B)</p> Signup and view all the answers

Match the following meningeal layers with their characteristics:

<p>Dura mater = Tough, outer layer Arachnoid mater = Middle layer with web-like trabeculae Pia mater = Thin, inner layer adhering to the brain</p> Signup and view all the answers

Which of the following is contained within the subarachnoid space?

<p>Cerebrospinal fluid and major brain arteries (D)</p> Signup and view all the answers

Which structure anchors the spinal cord within the subarachnoid space and is a filamentous extension from the conus medullaris?

<p>Filum terminale</p> Signup and view all the answers

Epidural hematomas typically extend beyond suture lines.

<p>False (B)</p> Signup and view all the answers

Subdural hematomas are typically caused by the rupture of ______ veins.

<p>bridging</p> Signup and view all the answers

Which of the following is a common cause of subarachnoid hemorrhage?

<p>Rupture of a cerebral aneurysm (D)</p> Signup and view all the answers

During a lumbar puncture, at which interspace is the spinal needle typically inserted?

<p>L3-4 or L4-5</p> Signup and view all the answers

Where are meningiomas most likely to originate, specifically?

<p>arachnoid cap cells (C)</p> Signup and view all the answers

The lateral ventricles drain into the third ventricle via the _______.

<p>interventricular foramina</p> Signup and view all the answers

Which structure connects the third and fourth ventricles?

<p>Cerebral aqueduct (B)</p> Signup and view all the answers

What structures produce cerebrospinal fluid within the ventricles?

<p>choroid plexuses</p> Signup and view all the answers

The cisterna magna is the smallest of the basal cisterns.

<p>False (B)</p> Signup and view all the answers

What is the most likely origin of a meningioma located internally to the occipital bone, inferior to the straight sinus and overlapping the falx cerebelli?

<p>Falx Cerebelli (B)</p> Signup and view all the answers

In a patient presenting with diplopia and an MRI showing a large fusiform aneurysm completely filling the ambient cistern, which cranial nerve is most likely affected?

<p>Trochlear Nerve (D)</p> Signup and view all the answers

Which of the following best describes the lesion revealed in a CT scan of a homeless man who may be sleeping outside showing a long and thin hyperdense lesion that does not respect suture lines, extends from the frontal pole to the parietal area?

<p>Subdural Hemorrhage (C)</p> Signup and view all the answers

Which structures are indicated by arrows on a brain scan?

<p>Tentorium cerebelli (C)</p> Signup and view all the answers

An 89-year-old man presents with increasing forgetfulness, but MRI findings show enlarged ventricles without any brain lesions. What is the most likely underlying condition?

<p>Hydrocephalus ex vacuo (E)</p> Signup and view all the answers

What is the approximate cerebrospinal fluid (CSF) production rate per 24-hour period in an adult?

<p>425 to 500 ml/day (D)</p> Signup and view all the answers

A 62-year-old woman presents with a sudden headache, and a CT scan reveals a small amount of subarachnoid blood and a calcified glomus choroideum. Where is this structure typically located?

<p>Atrium of the Lateral Ventricle (E)</p> Signup and view all the answers

An 84-year old patient suffers damage to the posterior part of the frontal, the parietal and medial portions of the temporal lobes of the left cerebral hemisphere. Which of the following arteries gives blood supply to those areas?

<p>Middle cerebral artery (D)</p> Signup and view all the answers

In a fall from a horse, a rider sustains a severe neck injury at the C6 level with the left transverse process fractured. Which artery is most likely endangered?

<p>Vertebral (A)</p> Signup and view all the answers

Dural venous sinuses lack valves and muscular walls.

<p>True (A)</p> Signup and view all the answers

A patient has lateral sella turcica damage, connecting multiple veins in that region. Which of the following has been damaged?

<p>Cavernous Sinus (B)</p> Signup and view all the answers

What are the structures that venous drainage passes through in order that begins the Cerebral veins and ends with the Internal Jugular Vein?

<p>Dural venous sinuses</p> Signup and view all the answers

Fusiform aneurysms involves dilatation of _______ arteries.

<p>large</p> Signup and view all the answers

What type of aneurysm is most common at arterial bifurcations?

<p>Saccular (B)</p> Signup and view all the answers

Hypertension is not the most common cause of intracerebral hemorrhage.

<p>False (B)</p> Signup and view all the answers

A hypertensive patient develops intracerebral hemorrhaging. Which of the following locations can be identified that makes this highly possible?

<p>basal ganglia (D)</p> Signup and view all the answers

Describe and name the phenomenon in which patients who were otherwise at baseline/lucid then present with symptoms.

<p>lucid interval</p> Signup and view all the answers

With a CT scan, a Subarachnoid Hemorrhage (SAH) shows hypodense blood in the subarachnoid space.

<p>False (B)</p> Signup and view all the answers

Match the brain herniation with its description:

<p>Transtentorial (uncal) Herniation = Involves medial temporal lobe 'uncus' herniation, possible blown pupil Central Herniation = Downward displacement of the brainstem due to increased intracranial pressure. Tonsillar Herniation = Involves the cerebellar tonsils downward, leading to respiratory arrest and blood pressure instability Subfalcine Herniation = Cingulate gyrus under the falx cerebri, can occlude anterior cerebral arteries</p> Signup and view all the answers

What can Subfalcine Herniation possibly occlude what vessels?

<p>Anterior cerebral vessels (A)</p> Signup and view all the answers

A 25-year-old man is brought to the emergency department after being hit on the head with a bottle and displays dilated and inferolaterally abducted left pupil. His CT shows a mass effect convex lesion, what is the likely best description for his presentation?

<p>Extra-axial injury; supratentorial; secondary brain injury (A)</p> Signup and view all the answers

A 72-year-old man presents 5 days after a fall with worsening headache/memory issues, a history of hypertension and alcohol abuse. The CT scan is consistent with the diagnosis. Which of the following mechanisms is most likely?

<p>Rupture of bridging veins (E)</p> Signup and view all the answers

Following acute right-sided weakness due to a sylvian fissure issue and basal cisterns and uses cocaine, indicate vasospasm-induced cerebral ischemia; what is the SAH from? The explanation is: The patient has ______

<p>subarachnoid hemorrhage</p> Signup and view all the answers

Which layer of the dura mater is avascular?

<p>Meningeal (B)</p> Signup and view all the answers

The Filum terminale internum is a dural segment.

<p>False (B)</p> Signup and view all the answers

What type of lesion is commonly associated with a skull fracture and appears biconvex on neuroimaging?

<p>epidural hematoma</p> Signup and view all the answers

The largest dural reflection, which separates the right and left cerebral hemispheres, is known as the____________.

<p>falx cerebri</p> Signup and view all the answers

Match the following dural reflections with their locations or functions:

<p>Falx cerebri = Separates the two cerebral hemispheres Tentorium cerebelli = Separates the occipital lobe from the cerebellum Falx cerebelli = Partially separates the cerebellar hemispheres Diaphragma sellae = Covers the hypophyseal fossa</p> Signup and view all the answers

Which of the following structures provides innervation to the posterior cranial fossa?

<p>Cervical spinal nerves and Vagus nerve branches (A)</p> Signup and view all the answers

The Arachnoid mater is the innermost layer of the meninges.

<p>False (B)</p> Signup and view all the answers

The subarachnoid space contains which critical fluid and structures?

<p>cerebrospinal fluid and major arteries</p> Signup and view all the answers

The spinal cord is anchored within the subarachnoid space by ______________ and the filamentum terminale.

<p>denticulate ligaments</p> Signup and view all the answers

Match the hemorrhage with desciption or characteristics:

<p>Epidural hematoma = Associated with skull fractures and does not cross suture lines Subdural hematoma = Crescent-shaped and can cross suture lines Subarachnoid hemorrhage = Commonly caused by ruptured aneurysms</p> Signup and view all the answers

A spinal needle is typically inserted into which interspace for a lumbar puncture?

<p>L3-L4 or L4-5 (A)</p> Signup and view all the answers

Meningiomas always originate within the brain parenchyma itself.

<p>False (B)</p> Signup and view all the answers

What structures produce cerebrospinal fluid?

<p>choroid plexuses</p> Signup and view all the answers

The median aperture drains CSF into the __________.

<p>cisterna magna</p> Signup and view all the answers

Match the following arteries with the area they primarily supply.

<p>Anterior cerebral artery (ACA) = Medial surface of the frontal lobe Middle cerebral artery (MCA) = Lateral surface of the cerebral hemispheres Posterior cerebral artery (PCA) = Occipital lobe and visual cortex</p> Signup and view all the answers

Which dural venous sinus contains the internal carotid artery?

<p>Cavernous sinus (C)</p> Signup and view all the answers

Watershed zones are brain regions with a single blood supply that is very, very close to the brain tissue.

<p>False (B)</p> Signup and view all the answers

Damage to small, penetrating branches of cerebral arteries deep within the brain can cause what type of stroke?

<p>lacunar stroke</p> Signup and view all the answers

Vasospasms resulting from a subarachnoid hemorrhage typically occur _______ days after the initial hemorrhage.

<p>3-7</p> Signup and view all the answers

Which brain herniation is matched with a clinical definition?

<p>Cingulate = Herniation under the falx cerebri Central herniation = Traction of the abducens nerve during courses. Uncal herniation = Blown pupil and contralateral hemiparesis Tonsillar herniation = Compression of the medulla leading to respitory arrest</p> Signup and view all the answers

Flashcards

Meninges

Connective tissue surrounding the CNS

Dura Mater

The outermost bilaminar layer of meninges, providing protection for the CNS.

Falx cerebri

Largest, separates the right and left cerebral hemispheres

Tentorium cerebelli

Separates the occipital lobe from the cerebellum

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Tentorial branch of V1

Innervates the tentorium cerebelli and posterior falx cerebri

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Arachnoid Mater

Middle layer between the dura and pia mater

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Subarachnoid space

Contains cerebrospinal fluid and major brain arteries

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Pia Mater

Thin, fibrous inner layer adhering to the brain and spinal cord

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Epidural Hematoma

Caused by rupture/tear of the middle meningeal artery

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Subdural Hematoma

Rupture of a bridging vein between the dura and arachnoid mater

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Subarachnoid Hemorrhage

Caused by the rupture of a cerebral aneurysm

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Lumbar puncture

Needle typically inserted in the L3-4 or L4-5 interspace

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Meningiomas

Benign brain tumors arising from the arachnoid layer

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Ventricular System

Four interconnected cavities within the brain

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Lateral Ventricles

Largest ventricles located within the cerebral hemispheres

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Interventricular Foramina

Connects the lateral to the third ventricle

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Third Ventricle

Lies in the diencephalon, between thalamic hemispheres

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Cerebral Aqueduct

Drains the third ventricle into the fourth ventricle

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Fourth Ventricle

Located in the rhomboid fossa dorsal to the pons/medulla oblongata

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Subarachnoid/Basal Cisterns

Enlarged portions of subarachnoid space filled with CSF

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Aneurysm

Dilation of wall vessel at branching points

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ACom Rupture

Compromises optic chiasm causing hemianopia & visual acuity deficits

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PCom Rupture

Compresses Ipsilateral CNIII palsy causing mydriasis (blown pupil) & ptosis

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Main arterial systems

Internal carotid and Vertebrobasilar

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Circle of Willis

Connects anterior and posterior blood supplies to brain

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ACA (A1-A5)

Supplies frontal pole, medial, and superior brain surfaces

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MCA (M1-M4)

Supplies lenticulostriate arteries (basal ganglia)

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PCA (P1-P4)

Supplies the occipital lobes and posteromedial temporal lobes

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Vertebral Artery

The paired vertebral arteries travel through the transverse foramina

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Dural Venous Sinuses

Enlarged portions within the subarachnoid space

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Straight Sinus

Connects inferior sagittal sinus with Great Cerebral Vein to form Straight Sinus

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Cavernous Sinus

Located lateral to sella turcica, connects to multiple veins

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Cavernous Sinus Contents

Has CN III, IV, V1, V2, VI & internal carotid artery

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Venous drainage pathway

Venous drainage

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Confluence of sinuses

Meeting point of superior sagittal, straight, and transverse sinuses

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CBF

50-60mL / 100grams of brain

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Thrombosis

narrowing of lumen, usually at subintima (tapar el tubo grande)

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Atherogenesis

Formation to thrombus

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Ischemic Penumbra

Reduced perfusion, so it CAN come back from the almost dead

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CVST

Venous sinus occlusion due to serum hyperviscosity or hypercoagulability

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SAH

Bleeding into the subarachnoid space

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ICH

Hypertension (most common)

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Transtentorial

The medial temporal lobe “uncus” herniates through the tentorial notch

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Tonsillar

Herniation of the cerebellar tonsils downward through the foramen magnum

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Subfalcine

The cingulate gyrus can herniate under the falx cerebri.

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ICH

Hydrocephalus, Intracellular Edema...

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Study Notes

Meninges

  • Connective tissue that surrounds the CNS.

Dura Mater

  • One of the meninges whose other names are ectomeninx and pachymeninx
  • Composed of dense, irregular connective tissue arranged in two layers, the outermost bilaminar layer
  • Originates from the mesoderm
  • Has two layers:
    • The periosteal layer is vascular and innervated.
    • The meningeal layer is avascular.
  • The layers are mostly fused, except in areas that form venous sinuses and dural reflections. Venous sinuses and dural reflections compartmentalize the brain, forming septa that descent into the cranial cavity

Dura Reflections

  • Falx cerebri
    • Largest one of the dural reflections.
    • Separates the right and left cerebral hemispheres.
    • Anterior attachment point is the frontal crest and crista galli.
    • Posterior attachment point is the internal occipital protuberance.
  • Tentorium cerebelli
    • Second largest of the dural reflections.
    • Separates the occipital lobe from the cerebellum.
    • Rostral attachment happens at the clinoid processes (sphenoid).
    • Rostrolateral attachment happens at the petrous part (temporal bone).
    • Posterolateral attachment happens at the internal surface of occipital and parietal bones.
  • Falx cerebelli
    • Inferior to the tentorium cerebelli.
    • Partially separates the cerebellar hemispheres.
  • Diaphragma sellae
    • Hypophyseal fossa covering that forms the sella turcica roof.

Dura Mater Blood and Nerve Supply

  • Anterior cranial fossa
    • Has vascularity via the anterior meningeal artery from ethmoidal arteries
    • All three trigeminal branches innervate it
    • Anterior and posterior ethmoidal nerve (CN V1), meningeal branch of V2 (maxillary) n., plus a meningeal branch of V3 (mandibular) innervate the anterior cranial fossa
  • Middle cranial fossa
    • Has vascularity via the middle meningeal artery and the accessory meningeal artery, both from the maxillary artery
    • The V2 maxillary nerve innervates the middle cranial fossa
  • Posterior cranial fossa
    • Has vascularity via the meningeal branches from ascending pharyngeal and occipital arteries in addition to branches from vertebral arteries
    • Cervical spinal nerves (C2, C3, and sometimes C1) and meningeal branches of the Vagus nerve (CN X) innervate the posterior cranial fossa

Arachnoid Mater

  • A middle meningeal layer that lies between the dura mater and pia mater
  • Composed of loose, translucent connective tissue
  • Originates from the neural crest
  • Forms the outer boundary of the subarachnoid space.

Subarachnoid Space

  • Lies between the arachnoid layer and pia mater
  • Contains cerebrospinal fluid
  • Contains the brain's major arteries, like the Circle of Willis

Pia Mater

  • Innermost meningeal layer and is thin and fibrous
  • Composed of fibrous connective tissue, including reticular and collagen fibers
  • Adheres to the brain and spinal cord
  • Forms the inner boundary of the subarachnoid space.

Spinal Cord

  • Anchored in the subarachnoid space by:
    • Denticulate ligaments
    • Filamentum terminale
    • Provides filamentous extension between conus medullaris and coccyx
  • The true spinal epidural space is filled with vertebral venous plexus and fatty tissue.

Epidural Hematoma

  • Typically caused by traumatic head injury that leads to rupture/tear of the middle meningeal artery, and is associated with skull fractures
  • Resulting hemorrhage then separates the dura from inner aspect of the calvarium, accumulating within the epidural space
  • On neuroimaging, EDH shown as biconvex hyperdense lesion that doesn't cross suture lines, as dura mater is tightly adhered at the skull suture lines

Subdural Hematoma

  • Results from rupture of bridging vein, which leads to hemorrhage between the dura and arachnoid mater, in the subdural space
  • On neuroimaging, SDH appears as crescent-shaped hematoma that can cross suture lines, but doesn't cross the midline

Subarachnoid Hemorrhage

  • Commonly caused by the rupture of a cerebral aneurysm.

Lumbar Puncture

  • Spinal needle inserted between L3-4 or L4-5 interspace, and directed towards the umbilicus, to perform spinal anesthesia or lumbar puncture

Meningiomas

  • Usually benign, slow-growing tumors that originate in the arachnoid layer (specifically in the arachnoid cap cells of the arachnoid villi)
  • Can occur anywhere in the CNS that has a meningeal covering.

Ventricular System

  • Four interconnected cavities within the brain
  • Lateral ventricles (first and second ventricles)
    • Largest of the ventricles that sit in the cerebral hemispheres
    • Drain into the third ventricle via the interventricular foramina
  • Third ventricle
    • Lies in the diencephalon, between the two thalamic hemispheres
    • Drains into the fourth ventricle through the cerebral aqueduct of Sylvius (aka aqueduct of midbrain)
  • Fourth ventricle
    • Sits in the rhomboid fossa (dorsal to the pons/medulla oblongata)
    • Drains into the subarachnoid space
    • Employs openings, the median aperture/foramen of Magendie and 2 lateral foramina of Luschka
  • Choroid plexuses produce CSF (filtration of plasma) in the lateral, third, and fourth ventricles

Subarachnoid Basal Cisterns

  • Enlarged regions of the subarachnoid space filled with cerebrospinal fluid
  • Contain arteries, veins, and nerves
  • Necessary and interconnected for CSF circulation
  • Cisterna magna (largest of the basal cisterns)
    • Sits posterior to the medulla
    • The median aperture and lateral apertures drain CSF into the cisterna magna

Vascular System

  • Vasculature in brain
  • ACom - can compress optic chiasm and cause bitemporal hemianopia & visual acuity deficits, if ruptures -> ischemia in ACA distribution (contralateral lower extremity hemiparesis with sensory deficits)
  • MCA - If ruptured, can cause Ischemia in MCA distribution (contralateral upper extremity and lower facial hemiparesis with sensory deficits).
  • PCom - compress ipsilateral CNIII palsy -> mydriasis (blown pupil) & ptosis. "down & out eye”

Atherosclerosis

  • Plaque development occurs via macrophages becoming foam cells, resulting in fibrous overgrowth in the subintima which leads to adhesion of platelets and clot formation on plaques.
  • Clots may then migrate
  • Etiology may stem from Embolism, which may block flow distally, affecting watershed areas
  • Vertebral arteries
    • Arise from subclavian artery and feed into basilar area

Ischemic Stroke

  • Subdivided into acute ischemic stroke and transient ischemic attack
  • Relies on timing, as ischemic is longer than 24 hrs to allow for cell death during imaging
  • Divided into Thrombosis and Lacunar stroke
  • Thrombosis narrows lumen, usually at subintima.
  • Lacunar stroke involves narrowing of small lumen arteries.

Cerebrovascular Disease (thrombosis)

  • Includes: Pregnancy, cancer, OCPs (oral contraception pills), hypercoagulable states

Hemorrhage

  • Comes in as: Sudden severe headache, focal deficits, depressed level of consciousness/alterness
  • Sensitivity shown through MRA, Ct angiography, Dsa
  • Up to 50% mortality b4 arrival

ICH (Intracranial Hemorrhage)

  • Involves: sudden rupture of blood in vessels
  • Etiologies: hypertension ,basal ganglia location amyloid
  • Diagnosed via increased pressure or lesions via CT scan

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