Meninges, Blood Supply of the Brain, Sinuses

Question 1

The brain, as well as the spinal cord, is surrounded by three layers of membranes called ______.

Answer 1

meninges

Question 2

What are the three meninges?

Answer 2

dura mater, arachnoid mater, pia mater

Question 3

The tough, outer layer.

Answer 3

Dura Mater

Question 4

The delicate, middle layer.

Answer 4

Arachnoid Mater

Question 5

The inner layer firmly attached to the surface of the brain.

Answer 5

Pia Mater

Question 6

The ______ meninges are continuous with, and similar to, the spinal meninges through the foramen magnum, with one important distinction — the ______ mater consists of two layers, and only one of these is continuous through the foramen magnum.

Answer 6

cranial, cranial dura

Question 7

The ______ mater is a thick, tough, outer covering of the brain.

Answer 7

cranial dura

Question 8

The cranial dura mater consists of an ______ layer and an ______ layer.

Answer 8

outer periosteal, inner meningeal

Question 9

The ______ layer is firmly attached to the skull, is the periosteum of the cranial cavity, contains the meningeal arteries, and is continuous with the periosteum on the outer surface of the skull at the foramen magnum and other intracranial foramina.

Answer 9

outer periosteal

Question 10

The ______ layer is in close contact with the arachnoid mater and is continuous with the spinal dura mater through the foramen magnum.

Answer 10

inner meningeal

Question 11

The two layers of dura separate from each other at numerous locations to form two unique types of structures: ______ and ______.

Answer 11

Dural Partitions, Intracranial Venous Structures

Question 12

These project inward and incompletely separate parts of the brain.

Answer 12

Dural Partitions

Question 13

The ______ project into the cranial cavity and partially subdivide the cranial cavity.

Answer 13

dural partitions

Question 14

The dural partitions project into the cranial cavity and partially subdivide the cranial cavity. They include the?

Answer 14

Falx cerebri, Tentorium cerebelli, Falx cerebelli, Diaphragma sellae

Question 15

The ______ is a crescent-shaped downward projection of meningeal dura mater from the dura lining the calva that passes between the two cerebral hemispheres.

Answer 15

Falx cerebri

Question 16

It is attached anteriorly to the crista galli of the ethmoid bone and formal crest of the frontal bone.

Answer 16

Falx cerebri

Question 17

Posteriorly it is attached to and blends with the tentorium cerebelli.

Answer 17

Falx cerebri

Question 18

The ______ is a horizontal projection of the meningeal dura mater that covers and separates the cerebellum in the posterior cranial fossa from the posterior parts of the cerebral hemispheres.

Answer 18

Tentorium cerebelli

Question 19

It is attached posteriorly to the occipital bone along the grooves for the transverse sinuses. Laterally, it is attached to the superior border of the petrous part of the temporal bone, ending anteriorly at the anterior and posterior clinoid processes.

Answer 19

Tentorium cerebelli

Question 20

The anterior and medial borders of the tentorium cerebelli are free, forming an oval opening in the midline (the ______), through which the midbrain passes.

Answer 20

tentorial notch

Question 21

The ______ is a small midline projection of meningeal dura mater in the posterior cranial fossa.

Answer 21

Falx cerebelli

Question 22

It is attached posteriorly to the internal occipital crest of the occipital bone and superiorly to the tentorium cerebelli.

Answer 22

Falx cerebelli

Question 23

Its anterior edge is free and is between the two cerebellar hemispheres.

Answer 23

Falx cerebelli

Question 24

It is the final dural projection.

Answer 24

Diaphragma sellae

Question 25

This small horizontal shelf of meningeal dura mater covers the hypophyseal fossa in the sella turcica of the sphenoid bone.

Answer 25

Diaphragma sellae

Question 26

There is an opening in the center of the diaphragma sellae through which passes the ______, connecting the pituitary gland with the base of the brain, and any accompanying blood vessels.

Answer 26

infundibulum

Question 27

The arterial supply to the dura mater travels in the outer periosteal layer of the dura and consists of:

1. ______ arteries in the anterior cranial fossa.
2. ______ and ______ arteries in the middle cranial fossa.
3. ______ artery and other meningeal branches in the posterior cranial fossa.

Answer 27

anterior meningeal, middle, accessory meningeal, posterior meningeal

Question 28

All are small arteries except for the ______ artery, which is much larger and supplies the greatest part of the dura.

Answer 28

middle meningeal

Question 29

The anterior meningeal arteries are branches of the ______ arteries.

Answer 29

ethmoidal

Question 30

The middle meningeal artery is a branch of the ______ artery.

Answer 30

maxillary

Question 31

The middle meningeal artery enters the middle cranial fossa through the foramen spinosum and divides into ______ and ______ branches.

Answer 31

anterior, posterior

Question 32

The ______ branch of the middle meningeal artery passes in an almost vertical direction to reach the vertex of the skull, crossing the pterion during its course.

Answer 32

anterior

Question 33

The ______ branch of the middle meningeal artery passes in a posterosuperior direction, supplying this region of the middle cranial fossa.

Answer 33

posterior

Question 34

The ______ artery is usually a small branch of the maxillary artery that enters the middle cranial fossa through the foramen ovale and supplies areas medial to this foramen.

Answer 34

accessory meningeal

Question 35

The posterior meningeal artery and other meningeal branches supplying the dura mater in the posterior cranial fossa come from several sources:

1. The posterior meningeal artery, the terminal branch of the ______ artery, enters the posterior cranial fossa through the jugular foramen.
2. Meningeal branches from the ______ artery enter the posterior cranial fossa through the jugular foramen and the mastoid foramen.
3. A meningeal branch from the ______ artery arises as the vertebral artery enters the posterior cranial fossa through the foramen magnum.

Answer 35

ascending pharyngeal, occipital, vertebral

Question 36

Innervation of the dura mater is by small meningeal branches of all three divisions of the ______, the ______, and the first, second, and, sometimes, third ______.

Answer 36

trigeminal nerve [V1, V2, and V3], vagus nerve [X], cervical nerves

Question 37

In the anterior cranial fossa meningeal branches from the ______ nerves, which are branches of the ______, supply the floor and the anterior part of the falx cerebri.

Answer 37

ethmoidal, ophthalmic nerve [V1]

Question 38

Additionally, a meningeal branch of the ______ turns and runs posteriorly, supplying the tentorium cerebelli and the posterior part of the falx cerebri.

Answer 38

ophthalmic nerve [V1]

Question 39

The middle cranial fossa is supplied medially by meningeal branches from the ______ and laterally, along the distribution of the middle meningeal artery, by meningeal branches from the ______.

Answer 39

maxillary nerve [V2], mandibular nerve [V3]

Question 40

The posterior cranial fossa is supplied by meningeal branches from the first, second, and, sometimes, third ______ nerves, which enter the fossa through the foramen magnum, the hypoglossal canal, and the jugular foramen.

Answer 40

cervical

Question 41

The ______ is a thin, avascular membrane that lines, but is not adherent to, the inner surface of the dura mater.

Answer 41

arachnoid mater

Question 42

From its inner surface thin processes or trabeculae extend downward, cross the subarachnoid space, and become continuous with the pia mater.

Answer 42

Arachnoid mater

Question 43

Unlike the pia, the ______ does not enter the grooves or fissures of the brain, except for the longitudinal fissure between the two cerebral hemispheres.

Answer 43

arachnoid

Question 44

The ______ is a thin, delicate membrane that closely invests the surface of the brain.

Answer 44

pia mater

Question 45

It follows the contours of the brain, entering the grooves and fissures on its surface, and is closely applied to the roots of the cranial nerves at their origins.

Answer 45

Pia Mater

Question 46

There is a unique arrangement of meninges coupled with real and potential spaces within the cranial cavity. A ______ space is related to the dura mater, while a ______ space exists between the arachnoid mater and the pia mater.

Answer 46

potential, real

Question 47

The potential space between dura mater and bone is the ______. Normally, the outer or periosteal layer of dura mater is firmly attached to the bones surrounding the cranial cavity.

Answer 47

extradural space

Question 48

This potential space between dura and bone can become a fluid-filled actual space when a traumatic event results in a vascular hemorrhage.

Answer 48

Extradural Space

Question 49

Bleeding into the extradural space primarily due to rupture of a meningeal artery or less often from a torn dural venous sinus results in an ______.

Answer 49

extradural hematoma

Question 50

Anatomically, a true ______ space does not exist.

Answer 50

subdural

Question 51

Blood collecting in the subdural space (______) due to injury represents a dissection of the dural border cell layer, which is the most innermost lining of the meningeal dural.

Answer 51

subdural hematoma

Question 52

______ cells are flattened cells surrounded by extracellular spaces filled with amorphous material.

Answer 52

Dural border

Question 53

Bleeding due to the tearing of a cerebral vein as it crosses through the dura to enter a dural venous sinus can result in a ______.

Answer 53

subdural hematoma

Question 54

Deep to the arachnoid mater is the only normally occurring fluid-filled space associated with the meninges, the ______.

Answer 54

subarachnoid space

Question 55

It occurs because the arachnoid mater clings to the inner surface of the dura mater and does not follow the contour of the brain, while the pia mater, being against the surface of the brain, closely follows the grooves and fissures on the surface of the brain.

Answer 55

Subarachnoid Space

Question 56

The subarachnoid space surrounds the brain and spinal cord and in certain locations it enlarges into expanded areas (______). It contains ______ and blood vessels.

Answer 56

subarachnoid cisterns, cerebrospinal fluid (CSF)

Question 57

______ is produced by the choroid plexus, primarily in the ventricles of the brain.

Answer 57

Cerebrospinal fluid

Question 58

It is a clear, colorless, cell-free fluid that circulates through the subarachnoid space surrounding the brain and spinal cord.

Answer 58

Cerebrospinal Fluid

Question 59

The CSF returns to the venous system through ______. These project as clumps (______) into the superior sagittal sinus, which is a dural venous sinus, and its lateral extensions, the ______.

Answer 59

arachnoid villi, arachnoid granulations, lateral lacunae

Question 60

______ is a dilation of the cerebral ventricular system, which is due to either an obstruction to the flow of CSF, an overproduction of CSF, or a failure of reabsorption of CSF.

Answer 60

Hydrocephalus

Question 61

Cerebrospinal fluid is secreted by the ______ within the ______, ______, and ______ ventricles of the brain.

Answer 61

choroid plexus, lateral, third, fourth

Question 62

As the CSF is produced it passes from the lateral ventricles through the ______ (the foramina of ______) to enter the third ventricle.

Answer 62

interventricular foramina, Monro

Question 63

From the third ventricle the CSF passes through the cerebral aqueduct (aqueduct of ______) into the fourth ventricle, and from here it passes into the subarachnoid space via the midline foramen or the two lateral foramina (foramen of ______ and foramina of ______).

Answer 63

Sylvius, Magendie, Luschka

Question 64

The ______ passes around the spinal cord inferiorly, envelops the brain superiorly, and is absorbed through the arachnoid granulations in the walls of the dural venous sinuses.

Answer 64

CSF

Question 65

In adults almost ______ of CSF is produced per day.

Answer 65

half a liter

Question 66

In adults the commonest cause of hydrocephalus is an interruption of the normal CSF absorption through the ______. This occurs when blood enters the subarachnoid space after subarachnoid hemorrhage, passes over the brain, and interferes with normal CSF absorption.

Answer 66

arachnoid granulations

Question 67

To prevent severe hydrocephalus it may be necessary to place a small catheter through the brain into the ______ system to relieve the pressure.

Answer 67

ventricular

Question 68

Other causes of ______ include congenital obstruction of the aqueduct of Sylvius and a variety of tumors, where the mass obstructs the aqueduct.

Answer 68

hydrocephalus

Question 69

Rare causes of hydrocephalus include ______ tumors that secrete CSF.

Answer 69

choroid plexus

Question 70

In children, ______ is always dramatic in its later stages.

Answer 70

hydrocephalus

Question 71

The ______ increases the size and dimensions of the ventricle, and as a result the brain enlarges. Because the skull sutures are not fused, the head expands.

Answer 71

hydrocephalus

Question 72

______ in utero may make a vaginal delivery impossible, and delivery then has to be by caesarean section.

Answer 72

Cranial enlargement

Question 73

Both ______ and ______ enable a radiologist to determine the site of obstruction and in most cases the cause of the obstruction.

Answer 73

CT, MRI

Question 74

Leakage of ______ from the subarachnoid space may occur after any procedure in and around the brain, spinal cord, and meningeal membranes. These procedures include lumbar spine surgery, epidural injection, and CSF aspiration.

Answer 74

CSF

Question 75

In “______” syndrome, CSF leaks out of the subarachnoid space and through the dura mater for no apparent reason.

Answer 75

cerebrospinal fluid leak

Question 76

______ is a rare infection of the leptomeninges.

Answer 76

Meningitis

Question 77

The ______ are a combination of the arachnoid mater and the pia mater.

Answer 77

leptomeninges

Question 78

Infection of the meninges typically occurs via a ______ route, though in some cases it may be by direct spread or from the nasal cavities through the cribriform plate in the ethmoid bone.

Answer 78

blood-borne

Question 79

Certain types of bacterial inflammation of the meninges are so virulent that overwhelming ______ and ______ with cerebral irritation can cause the patient to rapidly pass into a coma and die.

Answer 79

inflammation, sepsis

Question 80

Meningitis is usually treatable with ______.

Answer 80

antibiotics

Question 81

Certain types of bacteria that produce meningitis produce other effects; for example, ______ (ecchymoses) is a feature of meningococcal meningitis.

Answer 81

subcutaneous hemorrhage

Question 82

The typical history of meningitis is ______ at first.

Answer 82

nonspecific

Question 83

The patient may have mild headache, fever, drowsiness, and nausea. As the infection progresses, ______ (light intolerance) and ______ may ensue.

Answer 83

photophobia, ecchymosis

Question 84

Straight leg raising causes marked neck pain and discomfort (______) and an emergency hospital admission is warranted.

Answer 84

Kernig’s sign

Question 85

Determination of the anatomical structure from which a tumor arises is of the utmost importance, particularly when it arises within the ______.

Answer 85

cranial vault

Question 86

When assessing any lesion in the brain, it is important to define whether it is ______ (within the brain) or ______ (outside the brain).

Answer 86

intra-axial, extra-axial

Question 87

Typical extra-axial tumors include ______ (tumors of the meninges) and ______.

Answer 87

meningiomas, acoustic neuromas

Question 88

______ typically arise from the meninges, with preferred sites including regions at and around the falx cerebri, the free edge of the tentorium cerebelli, and the anterior margin of the middle cranial fossa.

Answer 88

Meningiomas

Question 89

______ are typically at and around the vestibulocochlear nerve [VIII] and in the cerebellopontine angle.

Answer 89

Acoustic neuromas

Question 90

Intra-axial lesions are either ______ or ______. By far the commonest type are the ______ brain lesions, which in most cases are metastatic tumor deposits.

Answer 90

primary, secondary, secondary

Question 91

______ lesions are typically found in patients with either breast carcinoma or lung carcinoma, though many other malignancies can give rise to cerebral metastases.

Answer 91

Metastatic tumor

Question 92

______ lesions are rare and range from benign tumors to extremely aggressive lesions with a poor prognosis.

Answer 92

Primary brain

Question 93

______ may occur at any age, though there is a small peak incidence in the first few years of life followed by a later peak in early to middle age.

Answer 93

Primary brain tumors

Question 94

The brain is a component of the ______.

Answer 94

central nervous system

Question 95

During development the brain can be divided into five continuous parts. From rostral (or cranial) to caudal they are:

•______ (Cerebrum)
•______
•______ (Midbrain)
•______
•______ (Medulla Oblongata)

Answer 95

TELENCEPHALON, DIENCEPHALON, MESENCEPHALON, METENCEPHALON, MYELENCEPHALON

Question 96

______ (______) becomes the large cerebral hemispheres. The surface of these hemispheres consists of elevations (______) and depressions (______), and the hemispheres are partially separated by a deep longitudinal fissure.

Answer 96

Telencephalon, cerebrum, gyri, sulci

Question 97

The ______ fills the area of the cranial cavity above the tentorium cerebelli and is subdivided into lobes based on position.

Answer 97

cerebrum

Question 98

______, which is hidden from view in the adult brain by the cerebral hemispheres, consists of the thalamus, hypothalamus, and other related structures, and classically is considered to be the most rostral part of the brainstem.

Answer 98

Diencephalon

Question 99

However, in common usage today, the term ______ usually refers to the midbrain, pons, and medulla.

Answer 99

brainstem

Question 100

The ______ (______) , which is the first part of the brainstem seen when an intact adult brain is examined, spans the junction between the middle and posterior cranial fossae.

Answer 100

mesencephalon, midbrain

Question 101

The ______, which gives rise to the ______ (consisting of two lateral hemispheres and a midline part in the posterior cranial fossa below the tentorium cerebelli) and the pons (anterior to the cerebellum, and is a bulging part of the brainstem in the most anterior part of the posterior cranial fossa against the clivus and dorsum sellae).

Answer 101

metencephalon, cerebellum

Question 102

The ______ (______), the caudalmost part of the brainstem, ends at the foramen magnum or the uppermost rootlets of the first cervical nerve and to which cranial nerves VI to XII are attached.

Answer 102

myelencephalon, medulla oblongata

Question 103

The brain receives its arterial supply from two pairs of vessels, the ______ and ______ arteries, which are interconnected in the cranial cavity to produce a ______ (of Willis).

Answer 103

vertebral, internal carotid, cerebral arterial circle

Question 104

The two vertebral arteries enter the cranial cavity through the foramen magnum and just inferior to the pons fuse to form the ______ artery.

Answer 104

basilar

Question 105

Each vertebral artery arises from the first part of each ______ artery in the lower part of the neck, and passes superiorly through the foramen transversarium of the upper ______ cervical vertebrae.

Answer 105

subclavian, six

Question 106

Continuing forward, the vertebral artery gives rise to three additional branches before joining with its companion vessel to form the basilar artery:

1. The first is a ______ artery.
2. A second branch is the ______ artery, which passes posteriorly around the medulla and then descends on the posterior surface of the spinal cord in the area of the attachment of the posterior roots—there are two posterior spinal arteries, one on each side.
3. A third branch joins with its companion from the other side to form the ______ artery, which then descends in the anterior median fissure of the spinal cord.

Answer 106

posterior inferior cerebellar, posterior spinal, single anterior spinal

Question 107

The basilar artery travels in a ______ direction along the anterior aspect of the pons. Its branches in a caudal to rostral direction include the ______ arteries, several ______ arteries, and the ______ arteries.

Answer 107

rostral, anterior inferior cerebellar, small pontine, superior cerebellar

Question 108

The basilar artery ends as a bifurcation, giving rise to two ______ arteries.

Answer 108

posterior cerebral

Question 109

The two ______ arteries arise as one of the two terminal branches of the common carotid arteries. They proceed superiorly to the base of the skull where they enter the carotid canal.

Answer 109

internal carotid

Question 110

Entering the cranial cavity each internal carotid artery gives off the ______ artery, the ______ artery, the ______ artery, and the ______ artery.

Answer 110

ophthalmic, posterior communicating, middle cerebral, anterior cerebral

Question 111

The ______ is formed at the base of the brain by the interconnecting vertebrobasilar and internal carotid systems of vessels. This anastomotic interconnection is accomplished by:

1. an ______ artery connecting the left and right anterior cerebral arteries to each other, and
2. two ______ arteries, one on each side, connecting the internal carotid artery with the posterior cerebral artery.

Answer 111

cerebral arterial circle (of Willis), anterior communicating, posterior communicating

Question 112

A stroke, or ______, is defined as the interruption of blood flow to the brain or brainstem resulting in impaired neurological function lasting more than 24 hours.

Answer 112

cerebrovascular accident (CVA)

Question 113

Neurological impairment resolving within 24 hours is known as a ______ or mini-stroke.

Answer 113

transient ischemic attack (TIA)

Question 114

Based on their etiology, strokes are broadly classified as either ______ or ______.

Answer 114

ischemic, hemorrhagic

Question 115

______ strokes are further divided into those caused by thrombotic or embolic phenomena. The latter is by far the commonest type of stroke and is often caused by emboli that originate from atherosclerotic plaques in the carotid arteries that migrate into and block smaller intracranial vessels.

Answer 115

Ischemic

Question 116

______ strokes are caused by rupture of blood vessels.

Answer 116

Hemorrhagic

Question 117

The symptoms and signs of a stroke depend on the distribution of impaired ______.

Answer 117

brain perfusion

Question 118

______ is a neurological emergency.

Answer 118

Stroke

Question 119

______ (blood-thinning) drugs can restore cerebral blood flow and improved patient outcome if administered within ______ hours of onset of the patient’s symptoms

Answer 119

Potent thrombolytic, 3 to 4.5

Question 120

Following initial clinical history taking and neurological examination, all patients with suspected stroke should undergo urgent brain imaging with ______.

Answer 120

computed tomography (CT)

Question 121

In ______ stroke, early CT imaging may appear normal or can show a relatively darker area of low density that corresponds to the region of abnormal brain perfusion.

Answer 121

ischemic

Question 122

If ______ is performed, a 24-hour follow-up CT scan is routinely carried out to evaluate for complications such as intracranial hemorrhage.

Answer 122

thrombolysis

Question 123

______ and ______ blood tests to identify causes such as hypoglycemia or underlying clotting disorders.

Answer 123

Hematological, biochemical

Question 124

A ______ may be useful to identify substance intoxication, which can mimic stroke.

Answer 124

toxicology screen

Question 125

The full extent of neurological injury can be evaluated on subsequent ______ of the brain, which has better soft tissue resolution compared to CT.

Answer 125

magnetic resonance imaging (MRI)

Question 126

______ is also useful for identifying strokes that may be too small to detect on a CT scan.

Answer 126

MRI

Question 127

______ scans are produced by using complicated algorithms that create a series of images, also known as ______.

Answer 127

MRI, sequences

Question 128

A ______, whether acute or chronic, will appear as a bright region on a sequence that is sensitive to fluid (T2 weighted).

Answer 128

stroke

Question 129

To identify whether a stroke is acute, further sequences are obtained, known as ______ and the ______ map.

Answer 129

diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC)

Question 130

If the region of abnormality appears bright on the DWI sequence and dark on the ADC map, this is known as ______, which is compatible with an acute stroke.

Answer 130

restricted diffusion

Question 131

Imaging of the ______ and ______ arteries is also performed to assess for any treatable atherosclerotic changes and stenosis.

Answer 131

carotid, vertebral

Question 132

Management of a stroke is ______.

Answer 132

multidisciplinary

Question 133

Long-term use of ______ drugs such as aspirin and modification of cardiovascular disease risk factors are important in the secondary prevention of stroke.

Answer 133

antiplatelet

Question 134

______ is a surgical procedure to remove atheromatous plaque from arteries.

Answer 134

Endarterectomy

Question 135

______ occur in the subendothelial layer of vessels and consist of lipid-laden macrophages and cholesterol debris.

Answer 135

Atheromatous plaques

Question 136

______ commonly occurs around vessel bifurcations, limiting blood flow, and may embolize to distal organs.

Answer 136

Plaque

Question 137

During ______, plaque is removed and the vessel reopened.

Answer 137

endarterectomy

Question 138

______ arise from the vessels in and around the cerebral arterial circle (of Willis).

Answer 138

Cerebral aneurysms

Question 139

They typically occur in and around the anterior communicating artery, the posterior communicating artery, the branches of the middle cerebral artery, the distal end of the basilar artery, and the posterior inferior cerebellar artery.

Answer 139

Intracerebral aneurysms

Question 140

As the aneurysm ruptures, the patient complains of a sudden-onset “______” headache that produces neck stiffness and may induce vomiting. In a number of patients death ensues, but many patients reach the hospital, where the diagnosis is established.

Answer 140

thunderclap

Question 141

An initial CT scan demonstrates blood within the subarachnoid space, and this may be associated with an intracerebral bleed. Further management usually includes ______, which enables the radiologist to determine the site, size, and origin of the aneurysm.

Answer 141

cerebral angiography

Question 142

Venous drainage of the brain begins internally as networks of small venous channels lead to larger cerebral veins, cerebellar veins, and veins draining the brainstem, which eventually empty into ______.

Answer 142

dural venous sinuses

Question 143

The dural venous sinuses are endothelial-lined spaces between the outer periosteal and the inner meningeal layers of the dura mater, and eventually lead to the ______.

Answer 143

internal jugular veins

Question 144

Also emptying into the dural venous sinuses are ______, which run between the internal and external tables of compact bone in the roof of the cranial cavity, and ______, which pass from outside the cranial cavity to the dural venous sinuses.

Answer 144

diploic veins, emissary veins

Question 145

The ______ veins are important clinically because they can be a conduit through which infections can enter the cranial cavity because they have no valves.

Answer 145

emissary

Question 146

The ______ include the superior sagittal, inferior sagittal, straight, transverse, sigmoid, and occipital sinuses, the confluence of sinuses, and the cavernous, sphenoparietal, superior petrosal, inferior petrosal, and basilar sinuses.

Answer 146

dural venous sinuses

Question 147

The ______ sinus is in the superior border of the falx cerebri. It begins anteriorly at the foramen cecum, where it may receive a small emissary vein from the nasal cavity, and ends posteriorly in the confluence of sinuses, usually bending to the right to empty into the right transverse sinus.

Answer 147

superior sagittal

Question 148

The ______ sinus communicates with lateral extensions (lateral lacunae) of the sinus containing numerous arachnoid granulations.

Answer 148

superior sagittal

Question 149

The ______ sinus usually receives cerebral veins from the superior surface of the cerebral hemispheres, diploic and emissary veins, and veins from the falx cerebri.

Answer 149

superior sagittal

Question 150

The ______ sinus is in the inferior margin of the falx cerebri. It receives a few cerebral veins and veins from the falx cerebri, and ends posteriorly at the anterior edge of the tentorium cerebelli, where it is joined by the great cerebral vein and together with the great cerebral vein forms the straight sinus.

Answer 150

inferior sagittal

Question 151

The ______ sinus continues posteriorly along the junction of the falx cerebri and the tentorium cerebelli and ends in the confluence of sinuses, usually bending to the left to empty into the left transverse sinus.

Answer 151

straight

Question 152

The ______ sinus usually receives blood from the inferior sagittal sinus, cerebral veins (from the posterior part of the cerebral hemispheres), the great cerebral vein (draining deep areas of the cerebral hemispheres), superior cerebellar veins, and veins from the falx cerebri.

Answer 152

straight

Question 153

The superior sagittal and straight sinuses, and the occipital sinus (in the falx cerebelli) empty into the ______, which is a dilated space at the internal occipital protuberance and is drained by the right and left transverse sinuses.

Answer 153

confluence of sinuses

Question 154

The ______ sinuses extend in horizontal directions from the confluence of sinuses where the tentorium cerebelli joins the lateral and posterior walls of the cranial cavity.

Answer 154

paired transverse

Question 155

The ______ sinus usually receives blood from the superior sagittal sinus and the ______ sinus usually receives blood from the straight sinus.

Answer 155

right transverse, left transverse

Question 156

The ______ sinuses also receive blood from the superior petrosal sinus, veins from the inferior parts of the cerebral hemispheres and the cerebellum, and diploic and emissary veins.

Answer 156

transverse

Question 157

As the transverse sinuses leave the surface of the occipital bone, they become the ______, which turn inferiorly, grooving the parietal, temporal, and occipital bones, before ending at the beginning of the internal jugular veins.

Answer 157

sigmoid sinuses

Question 158

The ______ sinuses also receive blood from cerebral, cerebellar, diploic, and emissary veins.

Answer 158

sigmoid

Question 159

The ______ sinuses are against the lateral aspect of the body of the sphenoid bone on either side of the sella turcica. They are of great clinical importance because of their connections and the structures that pass through them.

Answer 159

paired cavernous

Question 160

The ______ sinuses receive blood not only from cerebral veins but also from the ophthalmic veins (from the orbit) and emissary veins (from the pterygoid plexus of veins in the infratemporal fossa).

Answer 160

cavernous

Question 161

Structures passing through each cavernous sinus are: the ______ artery, and the ______ nerve.

Answer 161

internal carotid, abducent

Question 162

Structures in the lateral wall of each cavernous sinus are, from superior to inferior:

Answer 162

the oculomotor nerve [III], the trochlear nerve [IV], the ophthalmic nerve [V1], and the maxillary nerve [V2].

Question 163

Connecting the right and left cavernous sinuses are the ______ sinuses on the anterior and posterior sides of the pituitary stalk.

Answer 163

intercavernous

Question 164

______ sinuses drain into the anterior ends of each cavernous sinus. These small sinuses are along the inferior surface of the lesser wings of the sphenoid and receive blood from the diploic and meningeal veins.

Answer 164

Sphenoparietal

Question 165

The ______ sinuses drain the cavernous sinuses into the transverse sinuses.

Answer 165

superior petrosal

Question 166

Each ______ sinus begins at the posterior end of the cavernous sinus, passes posterolaterally along the superior margin of the petrous part of each temporal bone, and connects to the transverse sinus.

Answer 166

superior petrosal

Question 167

______ sinuses connect the inferior petrosal sinuses to each other and to the vertebral plexus of veins. They are on the clivus, just posterior to the sella turcica of the sphenoid bone.

Answer 167

Basilar

Question 168

______ is a common injury and is a significant cause of morbidity and death.

Answer 168

Head trauma

Question 169

______ may occur in isolation, but often the patient has other injuries; it should always be suspected in patients with multiple injuries. Among patients with multiple trauma, 50% die from the ______.

Answer 169

Head injury

Question 170

At the time of the initial head injury two processes take place. First the primary brain injury may involve ______, which results from the shearing deceleration forces within the brain. These injuries are generally not repairable.

Answer 170

primary axonal and cellular damage

Question 171

Further primary brain injuries include intracerebral hemorrhage and penetrating injuries, which may directly destroy gray and white matter. The ______ injuries are sequelae of the initial trauma.

Answer 171

secondary

Question 172

What are the types of Intracranial Hemorrhage?

Answer 172

Primary brain hemorrhage, Extradural hemorrhage, Subdural hematoma, Subarachnoid hemorrhage, Tuberculosis of the central nervous system, Concussion

Question 173

The many causes of a ______ include aneurysm rupture, hypertension (intracerebral hematoma secondary to high blood pressure), and bleeding after cerebral infarction.

Answer 173

primary brain hemorrhage

Question 174

An ______ is caused by arterial damage and results from tearing of the branches of the middle meningeal artery, which typically occurs in the region of the pterion. Blood collects between the periosteal layer of the dura and the calvaria and under arterial pressure slowly expands.

Answer 174

extradural hemorrhage

Question 175

A ______ results from venous bleeding, usually from torn cerebral veins where they enter the superior sagittal sinus. The tear and resulting seepage of blood separates the thin layer of dural border cells from the rest of the dura as the hematoma develops. Patients at most risk of developing this are the young and elderly. The increased CSF space in patients with cerebral atrophy results in a greater than normal stress on the cerebral veins entering the sagittal sinus. The clinical history usually includes a trivial injury followed by an insidious loss of consciousness or alteration of personality.

Answer 175

subdural hematoma

Question 176

______ may occur in patients who have undergone significant cerebral trauma, but typically it results from a ruptured intracerebral aneurysm arising from the vessels supplying and around the arterial circle (of Willis).

Answer 176

Subarachnoid hemorrhage

Question 177

______ may invade the central nervous system, including the brain, spinal cord, and meninges.

Answer 177

Tuberculosis (TB)

Question 178

______ (______) is the most common type of traumatic brain injury. The injury typically results from a rapid deceleration of the head or by a rotation of the brain within the cranial cavity.

Answer 178

Concussion, mild traumatic brain injury [MTBI]