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Neuro > 4 - Circulation to the Brain and Spinal Cord: CSF and Vascular Systems > Flashcards

4 - Circulation to the Brain and Spinal Cord: CSF and Vascular Systems Flashcards

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1
Q

CSF is formed in ____ (more specifically ___ ___) and flows between ventricles and into ____ space

A

ventricles, choroid plexus
subarachnoid space

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2
Q

2 functions of the CSF?

A
  1. supplying nutrients and removing waste products - it is then absorbed into venous system
  2. along with meninges, provides shock absorption to brain when head is hit
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3
Q

What is the lateral wall of the lateral ventricles?

A

caudate nucleus - with tail of caudate superior to inferior horn of lateral ventricle

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4
Q

What is below body of lateral ventricle? above?

A

below: thalamus
above: corpus callosum

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5
Q

what connects the lateral ventricles to each other and to 3rd ventricle?

A

interventricular foramina/foramina of Monro

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6
Q

The 3rd ventricle is narrow in midline of what?

A

diencephalon

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7
Q

what is the 3rd ventricle surrounded by?

A

thalamus and hypothalamus

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8
Q

what connects 3rd and 4th ventricles thru midbrain?

A

cerebral aqueduct/aqueduct of sylvius

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9
Q

4th ventricle is posterior to what? anterior to?

A

posterior to pons/medulla
anterior to cerebellum

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10
Q

what does the 4th ventricle connect to? (inferior of it)

A

central canal of spinal cord

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11
Q

what does the 4th ventricle drain into? through what?

A

drains into subarachnoid space through 2 lateral foramina (foramina of luschka) and midline foramen of Magendie

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12
Q

__ mater: outer layer firmly attached to inside of skull and inner layer attached to arachnoid

A

dura

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13
Q

dura mater: inner and out layers fused except where?

A

dural sinuses which collect CSF and venous blood

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14
Q

2 dense projections of inner layer of dura? locations?

A
  1. falx cerebri (sagittal)
  2. tentorium cerebelli (frontal)
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15
Q

Unique interaction between dura and arachnoid mater?

A

arachnoid mater has villi/granulation that go thru dura into venous sinuses to allow CSF flow into them

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16
Q

pia mater is connected to arachnoid through ___ ___ (collagen fibers) to allow suspension of brain in CSF?

A

arachnoid trabeculae

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17
Q

To make CSF, blood is filtered and transported thru which 3 layers?

A

web of (1) capillaries embedded in (2) connective tissue and (3) epithelial cells

  • creates a protein rich substance like plasma
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18
Q

Most often cause of epidural hematoma?

A

fx of parietal or temporal bones tearing middle meningeal artery

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19
Q

is an epidural hematoma usually a quick or slow accumulation of blood?

A

quick

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20
Q

is a subdural hematoma usually a quick or slow accumulation of blood?

A

slow

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21
Q

which hematoma is characterized with a period of lucidity then quick deterioration?

A

epidural

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22
Q

which hematoma is characterized by its “lens” shape?

A

epidural

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23
Q

what is a subdural hematoma most often due to?

A

venous bleed

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24
Q

what hematoma is characterized by a long broad crescent moon shape?

A

subdural

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25
is hydrocephalus congenital, acquired or either?
can be either
26
Triad of symptoms of hydrocephalus?
worsening gait, incontinence, HA or cognitive deficits
27
___ hydrocephalus occurs when the ventricular system is intact with blockage caudal to 4th ventricle
communicating
28
____/____ hydrocephalus occurs when the blockage is within the ventricular system (usually cerebral aqueduct)
noncommunicating/obstructive
29
what makes pain worse with meningitis?
upright position, head movement, sneezing or coughing
30
which homunculus is on the post central gyrus?
sensory
31
which homunculus is on the pre central gyrus?
motor
32
about how much of the spinal cord does the anterior spinal artery supply?
2/3
33
what is it called when arteries connect to abnormal vessels rather than capillaries to veins?
arteriovenous malformation (AVM) - congenital - can be asymptomatic until rupture - can be found anywhere in the brain
34
what is a thin walled outpouching from artery or vein?
aneurysm Can be congenital and worsen with age, HTN ► Or can develop with time ► Can be asymptomatic until it leaks or ruptures ► Can be found anywhere in circulatory system
35
what is the specialized barrier between capillary endothelium of CNS and extracellular space?
blood brain barrier
36
Blood brain barrier is absent in areas that __ the blood or ____ into the blood.
sample, secrete
37
where in the brain is the blood brain barrier absent?
Parts of hypothalamus and other areas close to 3rd/4th ventricles - Special ependymal cells separate “leaky” regions from barriered ones (like a barrier between the barrier and non-barrier regions)
38
O2 use ____ (inc/dec) from brainstem to cerebral cortices
increases - Cortex more vulnerable to O2 loss than life centers of brainstem - May explain why some people can live in persistent vegetative state for long time
39
Cerebral arteries autoregulate local blood flow dependent on blood pressure and metabolism. What would cause arteries to dilate?
- low BP - low O2 - low pH - high CO2 - high lactic acid
40
Cerebral arteries autoregulate local blood flow dependent on blood pressure and metabolism. What would cause arteries to constrict?
- high BP - high O2 - high pH - low CO2 - low lactic acid
41
Excessive fluid in brain tissue is known as what?
cerebral edema
42
3 potential causes of cerebral edema?
1. TBI, including concussion 2. heart attack 3. high altitude cerebral edema (HACE)
43
Cerebral edemas are often progressive because fluid pressure causes ___ then causing arterioles to dilate which increases ____ ____ and permeability and more edema
ischemia, capillary pressure 1. fluid pressure > ischemia 2. ischemia > arterioles to dilate 3. arterioles dilate > increased capillary pressure and permeability 4. increased capillary pressure and permeability > more edema
44
Intracranial pressure is monitored by a monitor placed where?
lateral ventricle
45
Normal intracranial pressure?
5-15 mmHg
46
Intracranial pressure above __ is abnormal and __ or greater is pathologic and contraindication to PT.
15, 20
47
What can excessive ICP do?
1. move brain structures 2. compress brain tissue 3. cause brain herniation 4. cause hydrocephalus 5. disrupt blood supply
48
4 types of brain herniation?
1. cingulate 2. uncal 3. central 4. tonsillar
49
what type of brain herniation causes pressure on the falx cerebri and can cause issues with the lower limbs?
cingulate
50
what type of brain herniation has pressure against the midbrain causes CN 3 dysfunction and LOC (reticular activating system)?
uncal
51
what type of brain herniation has pressure against diencephalon moving it, midbrain and pons down?
central
52
what type of brain herniation stretches basilar artery with brainstem ischemia/edema and causes B paralysis and impaired consciousness and oculomotor function?
central
53
what type of brain herniation has pressure of cerebellar tonsils on brainstem impair consciousness and 4th ventricle?
tonsillar
54
Venous system: spinal cord and medulla drain into small veins into ___ veins into ____ ___ ___
radicular, epidural venous plexus
55
Venous system: cerebral veins drain into dural sinuses into ___ ___ vein
internal jugular
56
Venous system: superficial veins drain cortex and neighboring white matter into ___ ___ __ or sinus at inferior cerebrum
superior sagittal sinus
57
Venous system: deep cerebral veins drain basal ganglia, diencephalon, adjacent white matter into ___ ___
straight sinus
58
Venous system: superior sagittal and straight sinuses meet at ___ ___ __
confluence of sinuses
59
Venous system: the ___ ___ arise from the confluence and drain into internal jugular vein
transverse sinuses
60
___ ___ ___: - brief localized loss of brain function - resolves within 24 hours - medical emergency due to high likelihood of bigger stroke to happen late (so it is a type of stroke)
transient ischemic attack
61
2 types of stroke?
infarction, hemorrhage
62
Stroke: infarction: embolus - where is the clot from? - timeline for loss of function?
Embolus: - clot from somewhere else - sudden, quick loss of function
63
Stroke: infarction: thrombus - where is the clot from? - timeline for loss of function?
thrombus: - narrowing and/or clot in area involved - gradual worsening of function (mins to days)
64
___% of all strokes are infarcts
80
65
what artery to most strokes affect?
middle cerebral artery
66
Stroke: slow occlusion of artery (years) can allow system to develop ____
compensations
67
Stroke: small deep circulation infarcts are called what?
lacunar infarcts - most common in basal ganglia, internal capsule, brainstem and one other place that i dont know
68
Hemorrhage stroke: slow leak or explosive rupture?
can be either - rupture will cause sudden LOfunction, severe HA, to loss of consciousness
69
Damage from a hemorrhage stroke is due to?
1. downstream loss of blood to brain areas 2. pressure of extracellular blood accumulating 3. blood where it is not supposed to be is irritant to brain tissue
70
STROKE: VERTEBRAL ARTERIES: - prone to what injuries? - symptoms?
- prone to shear force injuries, esp abrupt cervical rotation or hyperextension with chief symptom of pain - symptoms: 1. gait/limb ataxia/incoordination and weakness 2. oculomotor and oropharyngeal impairments 3. numbness 4. dizziness 5. HA 6. vomiting
71
STROKE: BASILAR ARTERIES - what does complete blockage cause? - what does partial blockage cause?
- complete blockage causes death due to ischemia of brainstem with vital functions - partial blockage can cause: 1. tetraplegia 2. numbness 3. LOC 4. cranial nerve damage example would be locked in syndrome
72
STROKE: ANTERIOR CEREBRAL ARTERY - what are the symptoms?
- hemiparesis/hemisensory loss to contralateral side (based on homunculus think lower limbs) - personality changes (like flat affect and impulsivity, gait apraxia)
73
STROKE: MIDDLE CEREBRAL ARTERY - symptoms? - based on each side?
- hemiparesis/hemisensory loss to contralateral side (based on homunuculus think face and upper limb) - L side: language - R side: spatial relationships, neglect, nonverbal communication
74
STROKE: POSTERIOR CEREBRAL ARTERY - supplies what? - symptoms?
- supplies midbrain, diencephalon, hippocampus (declaritive memory), thalamus (pain, contralateral hemiparesis/hemisensory loss) - eye movements - cortical blindness
75
STROKE: ____ ___ - anastomoses of distal branches of cerebral arteries - vulnerable to ischemia
watershed areas

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