Meninges and CSF

Question 1

Continuous fluid-filled system

Answer 1

Ventricular System

Question 2

The Ventricular System is composed of

Answer 2

o Lateral Ventricles
o 3rd Ventricle
o 4th Ventricle
o Central Canal

Question 3

BRAIN MENINGES
T or F:

The dura mater of the brain is formed from 2 layers.

Answer 3

TRUE

dura mater of the brain
outer periosteal layer
inner meningeal layer

single layer over spinal cord
epidural space between dural sheath and spinal cord

Question 4

BRAIN MENINGES

middle cob-web layer

Answer 4

Arachnoid

Question 5

BRAIN MENINGES

inner most delicate areolar connective tissue

Answer 5

pia mater

Question 6

BRAIN MENINGES

ordinary periosteum covering the inner surface of the skull bones

Answer 6

endosteal layer

Question 7

True of the Endosteal Layer

A. It does not extend through the foramen magnum to become continuous with the dura mater of the spinal cord

B. Around the margins of all the foramina it becomes continuous with the periosteum on the outside of the skull bones

C. At the sutures it is continuous with sutural ligaments

D. AOTA

Answer 7

D. AOTA

Question 8

BRAIN MENINGES

The dura mater proper is the

Answer 8

Meningeal layer

Question 9

Sickle- shaped fold of dura mater that lies in the midline between the 2 cerebral hemispheres

Answer 9

Falx Cerebri

Question 10

A small sickle- shaped fold of dura mater that is attached to the internal occipital crest and projects forward between the 2 cerebellar hemispheres .

Answer 10

Falx cerebelli

Question 11

Small circular fold of dura mater that forms the roof for sella turcica

Answer 11

Diaphragma Sellae

Question 12

T or F:

Dural nerve supply is sensitive to stretching which produces the sensation of headache.

Answer 12

TRUE

Question 13

BRAIN MENINGES

Dural nerve supply

Answer 13

Branches of the trigeminal, vagus, & first 3 cervical nerves and branches from the sympathetic system pass to the dura

Question 14

BRAIN MENINGES

Dural arterrial supply

Answer 14

Branches of the trigeminal, vagus, & first 3 cervical nerves and branches from the sympathetic system pass to the dura

Question 15

BRAIN MENINGES

The most important arterial supply which arise from the maxillary artery in the infratemporal fossa

Answer 15

middle meningeal artery

Question 16

BRAIN MENINGES

Meningeal veins lie in the

Answer 16

endosteal layer of dura

Question 17

BRAIN MENINGES

Delicate impermeable membrane covering the brain and lying between the pia internally and the dura externally

Answer 17

Arachnoid mater

Question 18

BRAIN MENINGES

The arachnoid mater is separated from the pia mater by

Answer 18

the subarachnoid space which is filled by CSF

Question 19

BRAIN MENINGES

Serve as sites where the CSF diffuse into the bloodstream

Answer 19

Arachnoid villi

Question 20

BRAIN MENINGES

Aggregations of arachnoid villi are referred as

Answer 20

arachnoid granulations

Question 21

BRAIN MENINGES

Vascular membrane that covers the gyri and descending into the deepest sulci

Answer 21

Pia mater

Question 22

T or F:

The cerebral arteries entering the brain carry a sheath of pia with them.

Answer 22

TRUE

Question 23

SC MENINGES

continuous with dura mater of brain

Answer 23

Dura mater of the SC

Question 24

SC MENINGES

Between dura mater and wall of vertebral column is epidural space filled with

Answer 24

Areolar connective tissue and blood vessels

Question 25

SC MENINGES | Adheres to surface of spinal cord and brain

Answer 25

Pia mater of the SC

Question 26

SC MENINGES T or F: Spinal cord is suspended in middle of dural sheath

Answer 26

True

Question 27

SC MENINGES | The SC is suspended by extensions of pia mater called

Answer 27

Denticulate ligaments

Question 28

SC MENINGES T or F: Laterally, spinal dura mater is continuous with the epineurium of spinal nerve at intervertebral foramina.

Answer 28

True

Question 29

SC MENINGES T or F: The SC arachnoid mater is continuous with cerebral arachnoid mater

Answer 29

TRUE

Question 30

SC MENINGES | An extension of pia beyond conus medullaris

Answer 30

Filum terminale

Question 31

SC MENINGES | How many pairs of triangular denticulate ligaments are there extending from the pia mater on each side to the dura sac

Answer 31

21 pairs

Question 32

SC MENINGES | 3 spaces between the 3 coverings

Answer 32

Epidural space Subdural space Subarachnoid space

Question 33

SC MENINGES | Largest part of the subarachnoid space extending from termination of the spinal cord to the level of S2(L2-S2)

Answer 33

Terminal cistern

Question 34

Formed mainly in the choroid plexuses of the lateral, third, and fourth ventricles

Answer 34

CSF

Question 35

Rate of secretion of CSF

Answer 35

0.5ml per min

Question 36

Total CSF volumes:

Answer 36

Adult 85 - 150 ml Neonate 10 - 60 ml Adult Rate of Formation 500 ml/day Turn over = 20 mL/hour

Question 37

Flow of CSF

Answer 37

Lateral ventricles ---> third ventricle through the interventricular foramina --> fourth ventricle through the narrow cerebral aqueduct ---> median aperture and the lateral foramina of the lateral recesses of the fourth ventricle ---> subarachnoid space ---> cerebellomedullary cistern and pontine cisterns ---> tentorial notch of the tentorium cerebelli to reach the inferior surface of the cerebrum

Question 38

2 communicating parts of the CSF circulation

Answer 38

Internal portion of the system two lateral ventricles, the interventricular foramens, the third ventricle, the cerebral aqueduct, and the fourth ventricle External part subarachnoid spaces and cisterns Communication between the internal and external portions occurs through the apertures of the fourth ventricle

Question 39

Main sites for the absorption of the CSF

Answer 39

Arachnoid villi

Question 40

Normal pressure of the CSF

Answer 40

10mmHg

Question 41

Accumulation CSF in the ventricles, or cavities, of the brain

Answer 41

Hydrocephalous

Question 42

2 types of Hydrocephalous

Answer 42

1. communicating hydrocephalous : fluid flows from the ventricular system into the subarachnoid space In communicating type blockage is in the subarchnoid space by blockage of arachnoid villi themselves 2. Non communicating : Fluid cant pass to the subarachnoid space blockage of the aqueduct of sylvius

Question 43

Functions of the CSF

Answer 43

Cushion and protect the CNS from trauma Provides mechanical buoyancy and support for the brain Serves as reservoir and assists in the regulation of the content of the skull Nourishes the CNS

Question 44

Composition of CSF

Answer 44

``` Major ions Oxygen Sugars (e.g., glucose, fructose, polyols) Lactate Proteins (e.g., albumin, globulins) Amino acids Urea Ammonia Creatinine Lipids Hormones (e.g., insulin) Histamines ```

Question 45

CSF glucose concentration is normally

Answer 45

60% of the plasma glucose concentration

Question 46

CSF:Serum albumin ratio

Answer 46

1:200 ratio implies that the entry rate of protein from the serum to the CSF is approximately 200 times less than its exit rate

Question 47

T or F: | Elevation in lumbar CSF protein is a nonspecific but sensitive indicator of CNS disease

Answer 47

TRUE

Question 48

T or F: | The presence of 1000 RBCs in the CSF results in the increase of protein by 1mg/dL

Answer 48

The presence of 1000 RBCs in the CSF results in the increase of protein by 1mg/dL

Question 49

A spinal-subarachnoid block result of a spinal cord tumor and can cause very significant elevations in CSF protein (greater than 1000mg/dL)

Answer 49

Froin's syndrome

Question 50

Clear and colorless, because it is more than 99% water

Answer 50

CSF

Question 51

Term used for CSF supernatant that is pink, orange or yellow

Answer 51

xanthochromic

Question 52

Follows a C-shaped course through all lobes of the cerebral hemisphere

Answer 52

Lateral Ventricles

Question 53

Most expanded part of the lateral ventricle

Answer 53

Trigone/Atrium

Question 54

Passageway between each lateral ventricle and the 3rd ventricle

Answer 54

Foramen of Monro

Question 55

Narrow, slit-like ventricle, occupies midline of the diencephalon

Answer 55

Third Ventricle

Question 56

Connects the 3rd and 4th ventricles, located within the midbrain, narrowest part of the ventricular system

Answer 56

Aqueduct of Sylvius

Question 57

Highly convoluted and vascularized material within the ventricles

Answer 57

Choroid Plexus

Question 58

Signs and Symptoms of Hydrocephalus

Answer 58

``` o Transillumination o “Sunset Eyes” o “Cracked pot” sign o Gaping Sutures o Persistent Fontanelles ```