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NEUROLOGY > Intracranial Space Occupying Lesions and Head Trauma > Flashcards

Intracranial Space Occupying Lesions and Head Trauma Flashcards

1
Q

What are space occupying lesions?

A

Abnormal tissue taking up space.

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2
Q

Increased ICP may result in contents doing what?

A

Herniating.

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3
Q

What are the 5 layers of the scalp?

A 
S - skin.
C - connective tissue.
A - aponeurosis.
L - loose connective tissue.
P - pericranium.
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4
Q

The scalp arteries form what?

A

A rich anastomotic network just deep to the skin.

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5
Q

As the scalp arteries form a rich anastomotic network, scalp lacerations and incisions are prone to what?

A

Bleeding excessively.

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6
Q

The right ophthalmic artery is a branch of what?

A

Right internal carotid artery.

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7
Q

What is the function of sutures (fibrous joints) of the skull?

A

Help to prevent skull fractures from spreading and thus minimise propagation.

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8
Q

Describe the pterion.

A
  • H-shaped.
  • Made up of frontal, parietal, temporal and sphenoid bones.
  • Thinnest part of skull.
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9
Q

Describe the relationship between the middle meningeal artery and the pterion.

A

The middle meningeal artery courses over the deep aspect of the pterion.

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10
Q

The groove across the deep surface of the pterion is made by what?

A

The R/L middle meningeal artery.

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11
Q

The groove between the deep surfaces of the temporal and occipital bones are made by what?

A

The R/L sigmoid sinus.

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12
Q

What is meningitis?

A

Usually a bacterial or viral infection of the meninges.

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13
Q

What are the meninges?

A

Protective coverings for the brain and spinal cord.

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14
Q

The brain and spinal cord are surrounded by how many layers of membrane?

A

Three.

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15
Q

Name the three layers of membrane surrounding the brain and spinal cord.

A
  • Dura mater.
  • Arachnoid mater.
  • Pia mater.
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16
Q

Describe dura mater.

A

“hard mother”.

  • Tough/fibrous layer receiving sensory supply from mainly CN V.
  • Encloses the dural venous sinuses.
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17
Q

Where are the dural venous sinuses enclosed?

A

Within the dura mater.

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18
Q

What does the arachnoid mater contain and what are their functions?

A

Arachnoid granulations that contain the circulating CSF.

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19
Q

Describe pia mater.

A

Adherent to the brain, the blood vessels and nerves entering/exiting the brain.

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20
Q

What is responsible for pain in meningitis?

A

Stretching of dura mater.

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21
Q

Dura mater is adherent to what?

A

Internal aspect of all bones of the skull.

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22
Q

What is diaphragm sellae?

A

A tough sheet of dura mater forming a roof over the pituitary fossa.

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23
Q

What is tentorium cerebelli?

A

Tough sheet of dura mater “tenting” over the cerebellum, attaching to the ridge of the petrous temporal bones with a central gap to permit the brainstem to exit.

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24
Q

What is falx cerebri?

A

Midline structure made of dura mater attaching to the deep aspect of the skull and separating the right and left cerebral hemispheres.

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25
Q

What does falx cerebri attach to anteriorly?

A

Crista galli of the ethmoid bone.

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26
Q

What does falx cerebri attach to posteriorly?

A

Internal occipital protruberance of the occipital bone.

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27
Q

Falx cerebri separates what?

A

The right and left cerebral hemispheres.

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28
Q

Cerebral veins drain venous blood from the brain into what?

A

Dural venous sinuses.

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29
Q

The left sigmoid sinus drains into what at the jugular foramen?

A

The left internal jugular vein.

30
Q

Where is the confluence of the dural venous sinuses?

A

In the midline at the internal occipital protuberance deep to the external occipital protruberance.

31
Q

What is the danger triangle?

A

Area of potential for venous spread of infection from superficial to deep.

32
Q

Describe the path of the vertebral arteries to enter the cranial cavity.

A

Pass through transverse foraminae of cervical vertebrae then through foramen magnum to enter the cranial cavity.

33
Q

The right internal carotid artery becomes internal to the cranial cavity via what?

A

The carotid canal.

34
Q

The external carotid arteries remain external to the cranial cavity to supply what?

A

The neck, face and scalp.

35
Q

In the Circle of Willis, the right anterior cerebral artery supplies what?

A

The medial aspect of the right cerebral hemisphere.

36
Q

In the Circle of Willis, the right posterior cerebral artery supplies what?

A

The posterior aspect of the right cerebral hemisphere including the visual cortex.

37
Q

In the Circle of Willis, the left middle cerebral artery supplies what?

A

The lateral aspect of the left cerebral hemisphere.

38
Q

Describe the location of the Circle of Willis.

A

Inferior to the midbrain, closely related to the pituitary stalk and the optic chiasm within the subarachnoid space.

39
Q

Where is the subarachnoid space located?

A

Between arachnoid mater and pia mater.

40
Q

Describe the subarachnoid space.

A

A continuous space between arachnoid and pia mater completely surrounding both the brain and spinal cord to cushion and protect them.

41
Q

What is contained within the subarachnoid space.

A

CSF.

42
Q

Where is CSF produced?

A

In the choroid plexus of the ventricles of the brain.

43
Q

Where is CSF reabsorbed?

A

Into the dural venous sinuses via the arachnoid granulations.

44
Q

Where and how might the subarachnoid space be accessed?

A

Lumbar puncture at L3/4/5.

45
Q

Where does the subarachnoid space end?

A

Inferiorly at the level of the S2 part of the sacrum.

46
Q

What ventricle of the brain is found in the midline within the diencephalon?

A

3rd ventricle.

47
Q

The cerebral aqueduct connects what?

A

The third and fourth ventricles in the midline.

48
Q

What ventricle is found between the cerebellum and pons?

A

The 4th ventricle.

49
Q

The central canal of the spinal cord is continuous with what ventricle?

A

The 4th ventricle.

50
Q

CSF is secreted by what?

A

The choroid plexus.

51
Q

CSF is circulated from the R&L lateral ventricles via what into the 3rd ventricle?

A

Right and left foraminae of monro.

52
Q

CSF exits the 3rd ventricle via what into what?

A

Cerebral aqueduct into the 4th ventricle.

53
Q

After CSF circulates from the 4th ventricle into the subarachnoid space what happens?

A

It is then reabsorbed from the subarachnoid space via the arachnoid granulations.

54
Q

What are arachnoid granulations?

A

Absorptive “herniations” of arachnoid mater protruding into the dural venous sinuses.

55
Q

CSF is reabsorbed by arachnoid granulations into what?

A

Dural venous sinuses.

56
Q

What is hydrocephalus?

A

Increased CSF volume due to:

  • Excessive CSF production.
  • Obstruction of flow.
  • Inadequate CSF reabsorption.
57
Q

How is hydrocephalus treated?

A

Ventricular peritoneal shunt.

58
Q

How is a ventricular peritoneal shunt placed?

A

“Tunnelled” beneath the skin of the neck and chest and then sited within the peritoneal cavity.

59
Q

Cerebral veins cross the subarachnoid space to drain into where?

A

The superior sagittal sinus.

60
Q

Describe an extradural haemorrhage.

A

Bleeding between the bone and dura due to ruptured middle meningeal artery often due to trauma to pterion.

61
Q

Describe a subdural haemorrhage.

A

Bleeding between dura and arachnoid mater due to torn cerebral veins often due to falls (in elderly/those with drinking problems).

62
Q

Describe a subarachnoid haemorrhage.

A

Bleeding into the CSF of subarachnoid space due to ruptured Circle of Willis - “Berry” aneurysm or congenital aneurysm.

63
Q

Damage to the extradural venous plexus can result in what?

A

Epidural haematoma compressing the spinal cord or cauda equina.

64
Q

What is the final destination of the epidural catheter?

A

Epidural space.

65
Q

What is the final destination of the lumbar puncture?

A

Subarachnoid space.

66
Q

Where does the spinal cord end?

A

L2

67
Q

What does the cauda equina consist of?

A

L2-Co spinal nerve roots descending towards their intervertebral foramina.

  • Motor roots anteriorly.
  • Sensory roots posteriorly.
68
Q

What types of supratentorial herniation are there?

A
  • Cingulate (subfalcine).
  • Central.
  • Uncal (uncus -medial part of temporal lobe that herniates inferior to tentorium cerebelli).
  • Transcalvarial.
69
Q

What types of infratentorial herniation are there?

A
  • Upward.

- Downward or tonsillar herniation (herniation of cerebellar tonsils - herniated into foramen magnum).

70
Q

Compression of the oculomotor nerve by uncal herniation leads to what?

A

Ipsilateral fixed dilated pupil.

NEUROLOGY (43 decks)

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