Podcast
Questions and Answers
The dura mater is a single-layered structure.
The dura mater is a single-layered structure.
False (B)
Which of the following dural reflections separates the right and left cerebral hemispheres?
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?
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?
What is the space between the arachnoid mater and pia mater called?
Which of the following structures anchors the spinal cord within the subarachnoid space?
Which of the following structures anchors the spinal cord within the subarachnoid space?
An epidural hematoma typically extends beyond the suture lines of the skull.
An epidural hematoma typically extends beyond the suture lines of the skull.
Which type of hematoma is characterized by a crescent-shaped appearance on neuroimaging and can cross suture lines?
Which type of hematoma is characterized by a crescent-shaped appearance on neuroimaging and can cross suture lines?
A subarachnoid hemorrhage is most commonly caused by the rupture of a cerebral ______.
A subarachnoid hemorrhage is most commonly caused by the rupture of a cerebral ______.
During a lumbar puncture, which interspace is typically used for needle insertion?
During a lumbar puncture, which interspace is typically used for needle insertion?
Meningiomas are typically malignant and fast-growing tumors.
Meningiomas are typically malignant and fast-growing tumors.
Which of the following is the most common location for meningiomas?
Which of the following is the most common location for meningiomas?
What is the largest of the four interconnected cavities within the brain?
What is the largest of the four interconnected cavities within the brain?
Which structure connects the lateral ventricles to the third ventricle?
Which structure connects the lateral ventricles to the third ventricle?
The cerebral aqueduct is the least common site of stenosis within the ventricular system.
The cerebral aqueduct is the least common site of stenosis within the ventricular system.
The fourth ventricle drains into the subarachnoid space via which foramina?
The fourth ventricle drains into the subarachnoid space via which foramina?
Cerebrospinal fluid (CSF) is produced by the ______ in the ventricles.
Cerebrospinal fluid (CSF) is produced by the ______ in the ventricles.
Which of the following is the largest of the basal cisterns and located posterior to the medulla?
Which of the following is the largest of the basal cisterns and located posterior to the medulla?
Subarachnoid cisterns are devoid of arteries and veins.
Subarachnoid cisterns are devoid of arteries and veins.
The median and lateral apertures drain CSF into which cistern?
The median and lateral apertures drain CSF into which cistern?
Match the following cerebral arteries with the brain regions they primarily supply:
Match the following cerebral arteries with the brain regions they primarily supply:
What are the venous channels located between layers of dura mater called?
What are the venous channels located between layers of dura mater called?
Dural venous sinuses contain valves and muscular walls.
Dural venous sinuses contain valves and muscular walls.
Which vein is formed by the union of internal cerebral veins and drains into the straight sinus?
Which vein is formed by the union of internal cerebral veins and drains into the straight sinus?
Name one structure contained in the cavernous sinus
Name one structure contained in the cavernous sinus
Which sinus directly receives blood from the superior sagittal sinus and the straight sinus?
Which sinus directly receives blood from the superior sagittal sinus and the straight sinus?
Cerebral veins eventually drain into the dural venous sinuses, which then drain into the ______.
Cerebral veins eventually drain into the dural venous sinuses, which then drain into the ______.
Which of the following accurately describes a lacunar stroke?
Which of the following accurately describes a lacunar stroke?
The goal of treatment for ischemic stroke is to decrease perfusion to the penumbra.
The goal of treatment for ischemic stroke is to decrease perfusion to the penumbra.
What is the most common cause of subarachnoid hemorrhage (SAH)?
What is the most common cause of subarachnoid hemorrhage (SAH)?
A classic symptom of subarachnoid hemorrhage (SAH) is a sudden, severe headache described as a ______ headache.
A classic symptom of subarachnoid hemorrhage (SAH) is a sudden, severe headache described as a ______ headache.
Match each type of intracranial hemorrhage with its typical location or associated vessel:
Match each type of intracranial hemorrhage with its typical location or associated vessel:
Which of the following is a classic symptom triad of increased intracranial pressure (ICP)?
Which of the following is a classic symptom triad of increased intracranial pressure (ICP)?
Sulci effacement on imaging suggests decreased intracranial pressure (ICP).
Sulci effacement on imaging suggests decreased intracranial pressure (ICP).
What is the likely cause given: 'Weber syndrome' = midbrain + one-sided CN III palsy + contralateral hemiparesis?
What is the likely cause given: 'Weber syndrome' = midbrain + one-sided CN III palsy + contralateral hemiparesis?
Why does arterial plaques/damage, more often than venous, cause strokes?
Why does arterial plaques/damage, more often than venous, cause strokes?
Having increased pressure inside head will increase cerebral blood flow.
Having increased pressure inside head will increase cerebral blood flow.
Which type of stroke is known for a watershed distribution causing proximal upper and lower extremity weakness?
Which type of stroke is known for a watershed distribution causing proximal upper and lower extremity weakness?
One way to test to help identify the cardiac source of an embolism is a ______ echos.
One way to test to help identify the cardiac source of an embolism is a ______ echos.
Which type of stroke is most commonly known for an elderly hypertension patient, suffering a small vessel disease?
Which type of stroke is most commonly known for an elderly hypertension patient, suffering a small vessel disease?
Which of the following is another name for the outermost bilaminar layer of the meninges?
Which of the following is another name for the outermost bilaminar layer of the meninges?
The periosteal layer of the dura mater is avascular and not innervated.
The periosteal layer of the dura mater is avascular and not innervated.
What structure do the layers of the dura mater form where they separate and descend into the cranial cavity?
What structure do the layers of the dura mater form where they separate and descend into the cranial cavity?
Which dural reflection is the largest and separates the right and left cerebral hemispheres?
Which dural reflection is the largest and separates the right and left cerebral hemispheres?
The tentorial branch of V1 innervates the tentorium cerebelli and the posterior third of the ______.
The tentorial branch of V1 innervates the tentorium cerebelli and the posterior third of the ______.
Which of the following cranial fossae is innervated by all three trigeminal branches?
Which of the following cranial fossae is innervated by all three trigeminal branches?
The arachnoid mater is composed of dense, irregular connective tissue.
The arachnoid mater is composed of dense, irregular connective tissue.
Match the following meningeal layers with their characteristics:
Match the following meningeal layers with their characteristics:
Which of the following is contained within the subarachnoid space?
Which of the following is contained within the subarachnoid space?
Which structure anchors the spinal cord within the subarachnoid space and is a filamentous extension from the conus medullaris?
Which structure anchors the spinal cord within the subarachnoid space and is a filamentous extension from the conus medullaris?
Epidural hematomas typically extend beyond suture lines.
Epidural hematomas typically extend beyond suture lines.
Subdural hematomas are typically caused by the rupture of ______ veins.
Subdural hematomas are typically caused by the rupture of ______ veins.
Which of the following is a common cause of subarachnoid hemorrhage?
Which of the following is a common cause of subarachnoid hemorrhage?
During a lumbar puncture, at which interspace is the spinal needle typically inserted?
During a lumbar puncture, at which interspace is the spinal needle typically inserted?
Where are meningiomas most likely to originate, specifically?
Where are meningiomas most likely to originate, specifically?
The lateral ventricles drain into the third ventricle via the _______.
The lateral ventricles drain into the third ventricle via the _______.
Which structure connects the third and fourth ventricles?
Which structure connects the third and fourth ventricles?
What structures produce cerebrospinal fluid within the ventricles?
What structures produce cerebrospinal fluid within the ventricles?
The cisterna magna is the smallest of the basal cisterns.
The cisterna magna is the smallest of the basal cisterns.
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?
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?
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?
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?
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?
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?
Which structures are indicated by arrows on a brain scan?
Which structures are indicated by arrows on a brain scan?
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?
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?
What is the approximate cerebrospinal fluid (CSF) production rate per 24-hour period in an adult?
What is the approximate cerebrospinal fluid (CSF) production rate per 24-hour period in an adult?
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?
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?
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?
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?
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?
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?
Dural venous sinuses lack valves and muscular walls.
Dural venous sinuses lack valves and muscular walls.
A patient has lateral sella turcica damage, connecting multiple veins in that region. Which of the following has been damaged?
A patient has lateral sella turcica damage, connecting multiple veins in that region. Which of the following has been damaged?
What are the structures that venous drainage passes through in order that begins the Cerebral veins and ends with the Internal Jugular Vein?
What are the structures that venous drainage passes through in order that begins the Cerebral veins and ends with the Internal Jugular Vein?
Fusiform aneurysms involves dilatation of _______ arteries.
Fusiform aneurysms involves dilatation of _______ arteries.
What type of aneurysm is most common at arterial bifurcations?
What type of aneurysm is most common at arterial bifurcations?
Hypertension is not the most common cause of intracerebral hemorrhage.
Hypertension is not the most common cause of intracerebral hemorrhage.
A hypertensive patient develops intracerebral hemorrhaging. Which of the following locations can be identified that makes this highly possible?
A hypertensive patient develops intracerebral hemorrhaging. Which of the following locations can be identified that makes this highly possible?
Describe and name the phenomenon in which patients who were otherwise at baseline/lucid then present with symptoms.
Describe and name the phenomenon in which patients who were otherwise at baseline/lucid then present with symptoms.
With a CT scan, a Subarachnoid Hemorrhage (SAH) shows hypodense blood in the subarachnoid space.
With a CT scan, a Subarachnoid Hemorrhage (SAH) shows hypodense blood in the subarachnoid space.
Match the brain herniation with its description:
Match the brain herniation with its description:
What can Subfalcine Herniation possibly occlude what vessels?
What can Subfalcine Herniation possibly occlude what vessels?
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?
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?
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?
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?
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 ______
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 ______
Which layer of the dura mater is avascular?
Which layer of the dura mater is avascular?
The Filum terminale internum is a dural segment.
The Filum terminale internum is a dural segment.
What type of lesion is commonly associated with a skull fracture and appears biconvex on neuroimaging?
What type of lesion is commonly associated with a skull fracture and appears biconvex on neuroimaging?
The largest dural reflection, which separates the right and left cerebral hemispheres, is known as the____________.
The largest dural reflection, which separates the right and left cerebral hemispheres, is known as the____________.
Match the following dural reflections with their locations or functions:
Match the following dural reflections with their locations or functions:
Which of the following structures provides innervation to the posterior cranial fossa?
Which of the following structures provides innervation to the posterior cranial fossa?
The Arachnoid mater is the innermost layer of the meninges.
The Arachnoid mater is the innermost layer of the meninges.
The subarachnoid space contains which critical fluid and structures?
The subarachnoid space contains which critical fluid and structures?
The spinal cord is anchored within the subarachnoid space by ______________ and the filamentum terminale.
The spinal cord is anchored within the subarachnoid space by ______________ and the filamentum terminale.
Match the hemorrhage with desciption or characteristics:
Match the hemorrhage with desciption or characteristics:
A spinal needle is typically inserted into which interspace for a lumbar puncture?
A spinal needle is typically inserted into which interspace for a lumbar puncture?
Meningiomas always originate within the brain parenchyma itself.
Meningiomas always originate within the brain parenchyma itself.
What structures produce cerebrospinal fluid?
What structures produce cerebrospinal fluid?
The median aperture drains CSF into the __________.
The median aperture drains CSF into the __________.
Match the following arteries with the area they primarily supply.
Match the following arteries with the area they primarily supply.
Which dural venous sinus contains the internal carotid artery?
Which dural venous sinus contains the internal carotid artery?
Watershed zones are brain regions with a single blood supply that is very, very close to the brain tissue.
Watershed zones are brain regions with a single blood supply that is very, very close to the brain tissue.
Damage to small, penetrating branches of cerebral arteries deep within the brain can cause what type of stroke?
Damage to small, penetrating branches of cerebral arteries deep within the brain can cause what type of stroke?
Vasospasms resulting from a subarachnoid hemorrhage typically occur _______ days after the initial hemorrhage.
Vasospasms resulting from a subarachnoid hemorrhage typically occur _______ days after the initial hemorrhage.
Which brain herniation is matched with a clinical definition?
Which brain herniation is matched with a clinical definition?
Flashcards
Meninges
Meninges
Connective tissue surrounding the CNS
Dura Mater
Dura Mater
The outermost bilaminar layer of meninges, providing protection for the CNS.
Falx cerebri
Falx cerebri
Largest, separates the right and left cerebral hemispheres
Tentorium cerebelli
Tentorium cerebelli
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Tentorial branch of V1
Tentorial branch of V1
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Arachnoid Mater
Arachnoid Mater
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Subarachnoid space
Subarachnoid space
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Pia Mater
Pia Mater
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Epidural Hematoma
Epidural Hematoma
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Subdural Hematoma
Subdural Hematoma
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Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
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Lumbar puncture
Lumbar puncture
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Meningiomas
Meningiomas
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Ventricular System
Ventricular System
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Lateral Ventricles
Lateral Ventricles
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Interventricular Foramina
Interventricular Foramina
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Third Ventricle
Third Ventricle
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Cerebral Aqueduct
Cerebral Aqueduct
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Fourth Ventricle
Fourth Ventricle
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Subarachnoid/Basal Cisterns
Subarachnoid/Basal Cisterns
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Aneurysm
Aneurysm
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ACom Rupture
ACom Rupture
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PCom Rupture
PCom Rupture
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Main arterial systems
Main arterial systems
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Circle of Willis
Circle of Willis
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ACA (A1-A5)
ACA (A1-A5)
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MCA (M1-M4)
MCA (M1-M4)
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PCA (P1-P4)
PCA (P1-P4)
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Vertebral Artery
Vertebral Artery
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Dural Venous Sinuses
Dural Venous Sinuses
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Straight Sinus
Straight Sinus
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Cavernous Sinus
Cavernous Sinus
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Cavernous Sinus Contents
Cavernous Sinus Contents
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Venous drainage pathway
Venous drainage pathway
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Confluence of sinuses
Confluence of sinuses
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CBF
CBF
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Thrombosis
Thrombosis
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Atherogenesis
Atherogenesis
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Ischemic Penumbra
Ischemic Penumbra
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CVST
CVST
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SAH
SAH
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ICH
ICH
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Transtentorial
Transtentorial
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Tonsillar
Tonsillar
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Subfalcine
Subfalcine
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ICH
ICH
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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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