Neuroanatomy Flashcards
(206 cards)
1
Q
Pterion
A
Weak part of skull
Where frontal, parietal, temporal bones meat.
2
Q
What artery runs over the pterion
A
Middle meningial artery
3
Q
CN in anterior fossa
A
CN I: cribiform plate
4
Q
CN of middle fossa
A
CN II: optic canal
CN III, IV, V1, VI: superior orbital fissure
CN V2: Foramen rotundum
CN V3: foramen ovale
5
Q
CN of posterior fossa
A
CN VII, VIII internal acoustic meatus
CN IX, X, XI: Jugular foramen
CN XII: hypoglossal canal
6
Q
Layers of the scalp
A
Skin
Connective tissue
Aponeurosis
Loose connective tissue (danger)
Pericranium (periostium)
7
Q
What space is the CSF stored
A
Subarachnoid space
8
Q
Meninges
A
Membranes that cover and protect brain and spinal chord (dura (tough), arachnoid (spider), pia (can’t be separated from brain))
9
Q
Epidural space
A
Potential space in brain, true space in spinal chord
Above dura mater.
Contains fat and internal vertebral venous plexus in the spinal chord
10
Q
Dura mater
A
Tough
One alyer aroung the spinal chord.
Two layers in cranial cavity eliminating epidural space of brain
11
Q
Subdural space
A
Potential space
Between dura mater and arachnoid
12
Q
Arachnoid mater
A
Thin
Avasculure
Pushed against dura mater
13
Q
Subarachnoid space
A
Filled with CSF in brain and spinal chord
Assessed during lumbar puncture.
Has vessels
14
Q
Pia mater
A
Adhering to spinal chord and brain
15
Q
Dural venous sinuses
A
Between periosteal and meningeal layers.
Drains CSF from subarachnoid space via arachnoid granulations
Drain into internal jugular vein at jugular foramina
No valves
16
Q
Falx cerebri
A
Dural partion
Separates two hemispheres of cerebrum
Vertical/longitudinal projection
17
Q
Falx cerebelli
A
Dural partition
Separates two hemispheres of verebellum
Vertical projection
18
Q
Tentorium cerebellum
A
Dural partition
Separates cerebruum from cerebellum
Horizontal/transverse projection
19
Q
Diaphragma sellae
A
Dural partition
Covers pituitary gland
Horizontal projection
20
Q
What nerves innervate the dura
A
Meningeal branches of V1 (optalmic)
Meningeal branches of V2 (maxillary)
Meningeal branches of V3 (mandibular
CN X
C1-C3
21
Q
Epidural (extradural) hematoma
A
Between periosteal layer of dura and bone
Doesn’t usually cross suture lines
Bi-convex shape (lens shape)
22
Q
Subdural hematoma
A
Between dura matter and arachnoid mater
Crescent shape
Cushing triad (HTN, resp depression, bradycardia)
23
Q
Subarachnoid hemorrhage
A
Fluid filled,
CSF and blood vessels
Ruptured aneurism
24
Q
Intracerebral hemorrhage
A
Blood vessel in brain ruptures causing brain bleed
25
Parenchyma
Functional tissue of organ
26
What is in brain parenchyma
Neurons and glial cells (neuroglia)
27
Meningitis
Inflammation of meningeal layers
28
Encephalitis
Inflammation or infection of brain tissue
29
Nucleus
Collection of nerve cell bodies in gray matter
30
Tracts
Axons and dendrites in the CNS allowing for communication
31
Gyrus
Ridges/hills of brian
32
Sulcus
Valleys of brain
33
longitudinal fissure
Devides cerebrun into left and right
34
Transverse fissure
Separates cerebrum from cerebellum
35
Lateral sulcus
Separates frontal and parietal lobes from temporal
36
Central sulcus
Separates the frontal and parietal lobes
Locates the major motor gyri on frontal lobe and sensory gyri on the parietal lobe
37
Parieto-occipital sulcus
Separates parietal and temporal lobes from occipital lobes
38
Calcarine sulcus
Separates into the occipital (visual) lobe into two parts
39
Frontal lobe jobs
Motor cortex
Personality
Problem solving
Impulse control
Organization
Social behavior
Attention
Language
40
Prmary motor cortex location
Pre-central gyrus
41
Primary somatosensory cortex location
Post-central gyrus
42
Parietal lobe jobs
Sensory cortex
Proprioception
Memory
Higher processing of attention
Numerical info
Emotion recognition
Self awareness
43
Nucleus gracilis
Sensory from below T6 (vibration, proprioception, fine touch)
44
Nucleus cuneatus
Sensory from above T6 (vibration, proprioception, fine touch)
45
Temporal lobe jobs
Auditory processing
Memory
Hippocampus
Emotional regulation and recognition
Olfaction
Emotions
Memory
46
Hippocampus
In temporal lobe
Transfers short term memory into long term
Most vulnerable to ischemic hypoxia
Alzheimers starts here
47
Alzheimer's disease
Cell loss in cortex and hippocampus
Sulcal dilation an enlargement
Depletion of neurotransmitters and neuropeptides
48
Broca's area
Frontal lobe
Motor output for speech production
Located in left frontal lobe for most
Speech is very effortful
49
Wernicke's area
Temporal lobe
Comprehension of written and spoken language
Speaking nonsense (word salad)
50
Global aphasia
Large lesion effecting broca's area, wernicke's area, arcuate fasciculus.
Often from infarction of internal carotid or middle cerebral artery
51
Occipital lobe jobs
Vision
Facial recognition
Color perceptionn
Spatial awareness
52
Basal ganglia
Coordinate muscle movements
53
Diseases caused by basal ganglia dysfunction
parkinson (loss of dopamine)
Huntington (loss of GABA)
Tourettes
54
Parkinson's pathology
Substantia nigra (neurons of midbrain) degenerate so theres less dopamine made
Mostly idiopathic
55
Insula
Fifth lobe of brian deep to the other lobes.
Works with social cues, empathy, understanding and predicting behaviors
56
Thalamus job
Sensory relay of signals to cortex.
regulates consciousness, sleep, alertness
Learning and memory
57
Hypothalamus job
Homeostasis via ANS and pituitary gland control
58
Pituitary gland job
Suspended from hypothalamus
Lies in hypophyseal fossa of sella turcica
59
Brain stem parts
Midbrain
Pons
Medulla oblongata
60
Brainstem jobs
Relay for ascending and descending tracts
Control movemet
Sleep and walking
Balance
Hearing
Cardiorespiratory center for HR, BP, and RR
Cough, sneeze, gag reflex
61
What cranial nerves come from brainstem
III-XII
62
Midbrain parts
CN III and IV
Cerebral aquaduct connecting third and fourth ventricles
63
Superior colliculus
Orientation of eye movements
64
Inferior colliculus
Auditory relay
65
What cranial nerves are on the pons
V-VIII
66
Medulla job
CN IX, X, XII
Major autonomic reflex center regulating heart, blood vessels, respiratory tract, GI tract, swallowing
67
Flow of CSF
Lateral ventricle--> Interventricular foramen (foramen of Monro)--> Third ventricle--> cerebral aqueduct--> Fourth ventricle --> Foramina of Luschka and foramen of Magendie--> Central canal (subarachnoid space)
68
What makes CSF
Choroid plexus
69
Arachnoid granulatoins
Absorb CSF.
Extensions of arachnoid matter in arachnoid space.
Drains into dural venous sinuses
70
Subfalcine bran herniation
Involves cingulate gyrus which is pushed around falx cerebri
71
Transtentorial (uncal) brain herniation
Involves medial temporal lobe.
Compressed by mass and goes under and across tentorium
72
Central brain herniation
Herniation of both temporal lobes through tentorial notch
73
Tonsillar brain herniation
Caused by infratentorial mass forcing cerebellar tonsils throgh foramen magnum
74
Upward brain herniation
Infratentorial mass compresses brainstem
Posterior fossa contents herniate upward around tentorium
75
Parasympathetic nerves
Craniosacral
(CN III, VII, IX, X, S2-S4)
Acetylcholine postsynaptic neurotransmitter
76
Sympathetic nerves
Thoracolumbar
T1-L3
Norepinephrine postsynaptic neurotransmitter
77
Sympathetic trunk
Ventral root--> ventral primary rami--> white rami--> sympathetic trunk
78
Three targets of autonomic visceral innervation
Cardiac plexus
Pulmonary plexus
Esophageal plexus
79
Parts of the internal carotid artery
Cervical (C1)
Petrous (C2)
Cavernous (C3)
Cerebral (C4)
80
What part of the internal carotid artery enters the carotid canal
Petrous
81
What does the cerebral portion of the internal carotid artery give rise to
Opthalmic
Middle cerebral
Anterior cerebral
82
Opthalmic artery
Branches from cerebral portion of ICA
Goes through optic canal with CN I
Supplies structures of the orbit and nasal cavity
83
Middle ceebral artery
More direct continuation of ICA
Travels laterally within lateral fissure
Supplies large portion of lateral aspects of the brain
Does NOT supply superolateral frontal and parietal lobes and inferior temporal lobes
84
Anterior cerebral artery
Travels superiorly then posteriorly within longitudinal fissure
Connect to wach other through anterior communicating artery.
Supplies medial parts of frontal and parietal lobes, olfactory bulbb and tract, and anterior and middle portions of corpus callosum
85
Vertebrobasilar system
Formed by vertebral arteries and basilar artery.
Supply posteroinferior portions of brain, cerebellum, brainstem, and some of the spinal cord
86
Vertebral arterires
Come off of subclavian
Ascend through foramina of C6-C1
Enter foramen magnum
Joiin basilar artery near pontomedullary junction
Give rise to posterior inferior cerebellar arteries, posterior and anterior spinal arteries
87
Posterior inferior cerebellar arteries
Give rise to posterior spinal arteries
Supply posterior 1/3 of spinal cord
88
Anterior spinal artery
Branches from vertebral collumn to supply anterior 2/3 of spinal cord
89
Basilar artery branches
Anterior inferior cerebellar arteries
Pontine branches
Superior cerebellar arteries
Posterior cerebral arteries
90
Anterior inferior cerebellar artery
Comes from basilar artery
Supplies anterior inferior portion of cerebellum
91
Pontine branches of basilar artery
Supply the pons
92
Superior cerebellar artery
Supplies the entire superior portion of cerebellum
93
Posterior cerebral artery
Terminating branch of basilar artery
Travel lateral and posterior within transverse fissure
Supplies midbrain, occipital lobe, temporal lobe, posterior corpus callosum
94
Cerebral veins
In subarachnoid space
Drain brain parenchyma
95
Bridging veins
Superior cerebral veins
Cross subarachnoid and subdural spaces to drain into sinuses
Pierce meninges and drain into dural venous sinus
96
Diploic veins
Drain flat bones of cranium
97
Emissary veins
Connect extracranial veins with intracranial dural sinuses
Pass from outside the cranial cavity to dural venous sinuses
Can spread infection to cranial cavity
98
Superior sagittal sinus
In the supeiror attached edge of falx cerebri
99
Inferior sagittal sinus
In the inferior free margin of falx cerebri
100
Great cerebral vein (of Galen)
Joins with inferior sagittal sinus to form straight sinus
101
Straight sinus
Attaches at junction of falx cerebri and tentorium cerebelli
Formed from junction of great cerebral vein and inferior sgittal sinus
102
Occipital sinus
In the attached margin of falx cerebelli along occipital bone
103
Confluence of sinuses
Dilated space at internal occipital protuberance.
Receives superior sagittal, straight, occipital sinuses
104
Transverse sinus (paired)
Horizontal extensions from confluence of sinuses along posterior and lateral attachments of tentorium cerebelli
Drains into sigmoid sinuses
105
Sigmoid sinuses (paired)
Continuation of transverse sinuses.
S-shaped
Internal jugular vein
106
Superior petrosal sinuses (paired)
Connects the cavernous sinus to transverse sinuses
107
Inferior petrosal sinuses (paired)
Connects cavernous sinus to sigmoid sinuses prior to jugular foramen
108
Cavernous sinus
On lateral saspect of body of sphenoid (sella turcica)
Receives deep veins of face, opthalmic, cerebral, and emissary veins
109
Saccular aneurysm
Looks like a berry on a vine
110
Fusiform aneurism
Whole circumference of section of artery is enlarged
111
CN I (olfactory)
Smell
Nerve cell bodies in olfactory epithelium
Cranial exit through foramina in cribiform plate of ethmoid bone.
Communicates with temporal lobe
112
Olfactory nerve dysfunction
Caused by damage to cribiform plate
Early symptom in parkinson's and alzheimers
Ansomia (loss of taste)
113
CN II (optic)
Vision
Retinal ganglion cells
Cranial exit optic canal via sphenoid bone
114
What crosses at the chiasma
Peripheral visual field nerve fibers
115
CN III (oculomotor)
Extraocular eye movements
Nerve cell bodies in midbrain
Cranial exit at superior orbital fissure
116
CN IV (trochlear)
Motor to superior oblique
Depression, abduction, intorsion
Nerve cell bodies on midbrain
Cranial exit from superior orbital fissure
117
CN IV deficits
Diplopia (double vision) when looking down
118
CN V1 (opthalmic of trigeminal)
Sensory of forehead
Nerve cell bodies from trigeminal ganglion
Cranial exit at superior orbital fissure
119
CN V2 (maxillary of trigeminal)
Sensory from skin over middle of face
Nerve cell bodies from trigeminal ganglion
Cranial exit at foramen rotundum
120
CN V3 (mandibular of trigeminal)
Sensory over mandible, anterior 2/3 of tongue, mouth mucosa
Motor for muscels of mastication, mylohyoid, anterior belly digastric, tensor veli palatini, tensor tympani
Sensory nerve cell bodies from trigeminal ganglion
Motor nerve cell bodies from pons
Cranial exit at foramen ovale
121
CN VI (abducens)
Motor to lateral rectus (turns eye laterally/abduction)
Nerve cell bodies on pons
Cranial exit at superior orbital fissure
122
CN VI deficits
Medial strabismus
123
CN III palsy symptoms
Ptosis (paralysis of levator palpebrae superioris)
Lack of pupillary light reflex
Lack of accomodatoin
Paralysis of EOM
124
CN VII (facial)
Motor to face, stapedius, stylohyoid, posterior belly of digastric
Taste to anterior 2/3 of tongue
Nerve cell bodies on pons
Cranial exit at internal acoustic meatus, facial canal, stylomastoid foramen.
125
CN VII parasympathetic functions
Saliva production at sublingual and submandibular glands
Tear production form lacrimal gland
Mucous glands of nasal cavity, maxillary sinus, and palate
126
CN VII deficits
Loss of corneal reflex (unable to blink)
Weakened or loss of facial movements.
Loss of taste from anterior 2/3 of tongue
Bells palsy
127
CN VIII (vestibulocochlear) vestibular part
Balance, sensation of semicircular ducts, utricle, and saccule
Nerve cell bodies at vestibular ganglion cranial exit at internal acoustic meatus
128
CN VIII (vestibulocochlear) cochlear part
Hearing from spiral organ
Nerve cell bodies at spiral ganglion
Cranial exit at internal acoustic meatus
129
CN IX (glossopharyngeal)
Parasympathetic to parotid gland
Gag reflex
Swallowing
Taste of posterior 1/3 of tongue
Sensory from carotid body and sinus
130
CN XI (accessory)
Motor to sternocleidomastoid and trapezius
Nerve cell bodies at medulla and spina cord (C1-C5)
Cranial entrance at foramen magnum
Cranial exit at jugular foramen
131
CN XII (hypoglossal)
Motor to tongue muscles other than palatoglossus
Nerve cell bodies at medulla and spinal cord
Cranial exit at hypoglossal canal
132
Cranial nerve parasympathetic fibers
CN III - sphincter of pupil and ciliary muscle
CN VII - Submandibular, sublingual, lacrimal, and nasal glands
CN IX - Parotid gland
CN X - Smooth muscle of trachea, bronchi, GI, and cardiac muscle of heart
133
What part of your vision would be affected by a parietal lesion
Lower
134
What part of your vision would be affected by temporal lesion
Upper
135
Parietal lobe job in vision
Spacial information
136
Temporal lobe job in vision
Recognition and visual memory
137
Anopsia
Total blindness of one or both eyes
Lesion optic nerve
138
Ipsilateral nasal hemianopsia
Loss of vision in one nasal field
Lesion on same side behind on lateral side of optic nerve before or after chiasm
139
Bitemporal heteronymous hemianopsia
Loss of peripheral (temporal) vision in both eyes
Lesion
140
Contralateral homonymous hemianopsia
Loss of peripheral(temporal) vision of one side and nasal of the other.
Lesion of entire nerve behind optic chiasm
141
Where to spinal nerves exit the vertebral canal
Intervertebral foramina
142
Zygapophyseal joints
joints between the facets on the superior and inferior articular processes
143
Intervertebral disc
Fibrocartilagenous joints located between vertebral bodies
Thick fibrous outer layer (anulus fibrosis)
Central softer portion (nucleus pulposus
144
Anterior longitudinal ligament
Located anterior to vertebral bodies
Strong and broad ligament extends from occipital bone to sacrum
Prevents hyperextension of spine
145
Posterior longitudinal ligament
Posterior to vertebral bodies
Prevents hyperflexion of spine
Thinner and narrower than anterior longitudinal ligament
Extends from C2 to sacrum
146
Supraspinous ligament
Connects each spinous process to the next
Limits flexion of spine
Continuous with nuchal ligament of neck
Extends from C7 to sacrum
147
Ligamentum flavum (yellow ligament)
Connects lamina of adjacent vertebrae
Limits flexion of spine
148
Interspinous ligaments
Connects spinous process of adjacent vertebrae
Limits flexion of spine
149
How far down does the spinal cord go
L2
150
How far down does the dural sac go
S2
151
Lumbar cistern
Subarachnoid space in lower lumbar region
152
Where is a lumbar puncture preformed and why
L3-L4 or L4-L5 to make sure spinal cord isn't damaged
153
What two structures help anchor spinal cord in place
Denticulate ligaments (sawtooth from pia that extend from spinal cord to dura mater)
Filum terminal (Interior extends off inferior tip of conus medullaris and attaches to inferior dural sac. External portion made of pia and dural and goes from dural sac to coccyx)
154
Ventral horn (anterior horn)
Contains cell bodies of neurons of motor tracts
Lower motor neurons in corticospinal tract
155
Dorsal horn (posterior horn)
Contains cell bodies of neurons that assist in sensory tracts
156
White matter
Axons
Central part of brain
Peripheral part of spinal cord
157
Gray matter
Cell bodies
Peripheral part of brain
Central part of spinal cord
158
Gracile fasciculus
In dorsal column
Extends entire spinal cord
Caarries afferent fiber for lower half of trunk and lower extrimities (T7 and below)
159
Cuneate fasciculus
In dorsal column
Only at T6 and above.
Carries afferent fibers from upper half of trunk and upper extremities
160
Where is white matter the thickest in spinal cord
Cervical (most ascending tracts have entered and not many descending have left yet)
161
Where is gray matter thickest in soinal cord
Lumbosacral regions
162
Spinal nerve
First structure where afferent and efferent (dorsal and ventral) (sensory and motor) fibers mix
163
Cervical enlargement
C5-T1
Increased amount of motor neurons for upper limbs
164
Lumbosacral enlargement
L2-S3
Increased amount of motor neurons for lower limbs
165
Cauda equina
Extends from conus medullaris and supplies innervation ot lower portion of body
Composed of nerve roots
Horse tail
In the lumbar cistern
166
What 3 longitudinal arteries supply the spinal cord
Anterior spinal artery (1) (anterior 2/3)
Posterior spinal arteries (2) (posterior (1/3)
167
Segmental spinal arteries
Help the anterior and posterior spinal arteries
Arise from vertbral, posterior intercostal, lumbar, and sacral arteries.
168
Artery of adamkiewicz (great anterior radiculomedullary artery)
Feeds into the anterior spinal artery in the lower thoracic and lumbar region
Usually comes from posterior intercostal, subcostal, or lumbar artery
169
Anterior and posterior spinal veins
Primary venous drainage of spinal cord
Directly connect to internal vertebral plexus
170
External vertebral veinous plexus
Located outside vertebral bodies
Connects with posterior intercosts, subcostal, and lumbar veins
171
Corticospinal tract
Descending (efferent/motor) fibers from primary motor cortex to spinal cord
2 neurons (UMN and LMN)
172
First order neuron of corticospinal tract
Cell body in. precentral gyrus
Axon descends through cerebral peduncle of midbrain through pons, and medullary pyramids
90% decussate in medullary pyramids 10% stay ipsilateral
Axon descends in white matter of spinal cord and synapses with ventral horn of spinal cord at appropriate level
173
Second order neuron of corticospinal tract
Cell body within ventral horn of gray matter of spinal cord
Axon exits spinal cord through ventral rootlets--> ventral root--> ventral/dorsal ramus--> named peripheral nerve
174
Upper motor neuron deficits
Spastic paralysis
Babinski
Hyperreflexia
175
Lower motor neuron deficitx
Flaccid paralysis
Hypoactive/abcent reflexes
No babinski
Decreased muscle tone
176
Spinothalamic tract
Ascending (afferent/sensory) carrying info for pain and touch
3 neuron system (first order, second order, third order)
177
First order neuron of spinothalamic tract
Receives pain/temp info via skin receptors
Axon travels from skin to dorsal root ganglion then from dorsal root ganglion to spinal cord and synapses at dorsal horn
178
Second order neuron of spinothalamic tract
Cell body within dorsal horn of spinal cord gray matter
Axon decussates through ventral white commissure and ascends through spinal cord and synapses with third order neuron in thalamus
179
Third order neuron of spinothalamic tract
Cell body within thalamus
Axon projects to postcentral gyrus
180
Dorsal column (medial lemniscus)
Ascending (afferent/sensory) detecting fine touch, vibratoin, two point discrimination, propriosception.
3 neurons (first, second, third order)
181
First order neuron of dorsal column tract
Receives sensory from skin receptors
Cell body located in dorsal root ganglion.
Axon tracels from skin to dorsal root ganlgion then dorsal root ganglion into the spinal cord
Ascends within dorsal column
182
Second order neuron of dorsal column tract
Cell body located within nuclei of inferior medulla (cuneate for upper limb, gracile for lower)
Axon immediately decussates then ascends through brainstem to thalamus
183
Third order neuron of dorsal column tract
Cell body in thalamus
Axon projects to corresponding region of postcentral gyrus
184
Cushing triad
Bradycardia, irregular respirations, widened pulse pressure
185
Contusion
Same thing as intraparenchymal hemorrhage
Bruise of brain
186
Epidural hematoma characteristics
Usually arterial (middle meningeal just deep to pterion)
Usuallly associated with skull fractures
Can also be from infection, coagulopathy, tumors, vascular malformation
187
Epidural hematoma presentation
Initial loss of consciuousness followed by complete recovery then rapid deteroration
Increased ICP
Ipsilateral pupil dilation from compresssion of CN III
Cushings triad
188
Epidural hematoma diagnostic imaging
CT shows biconvex (lens shape) that doesn't cross suture lines, swirl line would show active bleeding
MRI if suspicion of EDH with negative CT of head
Angiography if suspect dural arteriovenous fistula
189
Epidural hematoma treatment
Surgery depending on acuity, volume, midline shift, GCS, pupilary abnormalitiies
Craniotomy or Burr hole
190
Epidural hematoma treatment for non-operative
Serial neurologic exams
Follow up CT in 6-8 hrs
191
Subdural hematoma characteristics
Traumatic usually from bridging veins or cortical arteries
Can also be caused by low CSF pressure (intracranial hypotension), anticoagulation, cerebral atrophy, subdural hygroma, Can progress to chronic SDH
192
Subdural hematoma presentation
Headache, N/V, altered consciousness
Cushing's triad
193
Subdural hematoma diagnostic imaging
CT shows crescent shape that can cross suture lines
MRI if high suspicion of SDH with negative CT
Angiography if CTA or MRA can't find bleeding source
194
Subdural hematoma treatment
Surgery
Edffected by acuity, clot volume, midline shift, GCS, pupil abdnormalities
195
Subdural hematoma treatment for non-operative
ICP monitoring
Serial neurologic exams
Follow-up CT
196
Subarachnoid hemorrhage clinical presentation
Headache
N/V
Diplopia
Meningismus (neck stiffness)
Breif altered loss of consciousness
197
Subarachnoid diagnosis
CT
Lumbar puncture if CT is negative
CT angiography if SAH confirmed
198
Subarachnoid hemorrhage treatment
BP control
Aneurysm treatment (surgical clipping or endovascular coiling)
199
Incisura
Tentorial notch
200
What causes brain herniations
Anything that increases ICP
201
Amaurosis fugax
Transient, painless monocular visual loss from thromboembolic events of carotid arterial system.
Makes sense bc opthalmic artery comes off of ICA
Hollenhorst plaques seen in fundoscopic exam
202
Amaurosis fugax treatment
Carotid endarterectomy
203
Urgent lumbar puncture indications
Suspected CNS infection (meningitis)
Suspected SAH in pt with negative CT
204
Lumbar puncture contraindication
Possible ICP (AMS, focal neurologic signs, papilledema, seizure in past week, impaired cellular immunity)
Thrombocytopenia
Local injection site infection
Suspect spinal epidural abscess
205
Lumbar punture technique
L3/L4 or L4/L5
Clean skin
INject anesthetic
20-22 gauge spinal needle at 15º cephalad towards ubilicus
Needle bevel towards pt flank when sitting or superior/inferior when laying on side
206
Layers you go through for lumbar puncture
Skin
Subcutaneous tisuse
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
