Head and Neck - Lec 5

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what are the 3 causes/mechanisms of intracranial pressure

1. blockage of CSF in subarachnoid space 2. blood build up in other meningeal spaces (epidural,arachnoid,pia) 3. infection/inflammation of CSF

what 3 things does obstructive hydropcephalus cause

1. build up of CSF 2. increased volume in cranium 3. increased intracranial pressure

how can a meningioma cause morbidity

1. compress cranial contents 2. invade orbit cavity 3. compress dural venous sinus

what is in BSCB

1. endothelial cells with tight junctions 2.pericytes 3.astrocyte end feet 4.basal membrane

components of blood csf barrier

1. epithelial cells w/tight junction

what are the 3 components of the uvea

1. iris 2. ciliary body 3.choroid

what are the 2 components of the blood aqueous barrier

1. iris (endo) 2. ciliary body (epi)

if there is an uninterrupted aneurysm of posterior communicating artery, symptoms?

1. pain-CN 5 2. dilated pupil- CN 3 3. diplopia- CN 3 4. ptosis

where are the 2 barriers of blood csf barrier

1. physical (tight junctions & choroid epith) 2. enzymatic barrier (mechanisms)

what is terson's syndrom

1. pre-retinal hemorrhage 2. papilledema (bilateral) 3. intracranial hemorrhage

components of BBB

1.endothelial with tight junction 2.end feet of astrocytes 3.pericytes 4. basal membrane

how many barriers in BRB, what are they

2, inner and outer

what % of people die if not treated in 48 hours

20!

what CN is involved with posterior communicating artery

3

the headache is involved with what CN

5

what CN is involved w/ increased intracranial pressure

6

what is blood spinal cord barrier similar to and why

BBB both in CNS

herination of temporal lobe (uncus) over free edge tentorium compresses what nerve

CN3

if there is an uninterrupted aneurysm of posterior communicating artery, what nerve affected

CN3

what is double vision of subarachnoid caused by

CN3 if compressed by aneurysm of posterior communicating artery CN6 if compressed by pressure

if bleeding in trauma what kind of scan

CT scan

where does lumbar puncture need to happen

L3-L4 (subarachnoid space)

blood clot

MRI

if tumor block CSF what scan

MRI

any increased intracranial pressure can cause

RAS, compression of reticular activating system

what is idiopathic intracranial hypertension

a disease/cause which is unknown why

what is a meningioma

a tumor of the meninges

where do meningiomas typically trail/ can be found

along dura, dural tail

epidural hematoma can be fatal in how long

an hour

how is a subarachnoid hematom/hemmorhage caused

aneurysm

when orbital cavity is the main site of a meningioma where does it arise from

arachnoid

what kind of blood is a subarachnoid hematom/hemmorhage

arterial

what kind of blood is in an epidural hematoma/hemmorhage

arterial

what is reticular formation

awakened/conscious

aside from the optic disc being pushed foward papilledema is also caused by

axoplasmic stasis and extrusion from the cell membrane

where are tight junctions in BBB

between endothelial and capillaries

hemmorage

bleeding

subarachanoid is due to

bleeding of ruptured aneurysm

where is a epidural hematoma

bleeding on top of dura (between dura and skull)

what is a venous sinus thrombosis

bloot clot in DVS,

what does meningitis result in

breakdown of CSF barrier/ infection into CSF

what is the job of external cortical veins

bring venous blood to dural venous sinus

at what level is BBB found

capillary

what level is blood csf barrier

capillary

where is epidural hematomas mainly seen

children

where is CSF made

choroid plexus

BCSFB occurs at

choroid plexus epithelium

what produces epithelium

ciliary body epithelium

is a ventricle is compressed it causes

compression of CSF and obstructive hydrocephalus

what is RAS in charge of

consciousness

parasympathetic cause pupils to

constrict

overtime with compression of CNIII

damaged parasym so not dilating and droopy lid

if you have epidural hematoma would the pupil be dilated or constricted

dilated

so if parasympathetic isn't working due to compression from epidural hematoma

dilated pupils

compression of CN3 causes

dilation of pupil

where is RAS

dorsal brainstem

what does venous sinus thrombosis block

drainage of venous blood and CSF

what type of cells does BBB have

endothelial cells

what comprises inner BRB

endothelium w/ TJ, pericyte,astrocyte

which 2 hematomas cause CN3 palsy

epidural and subarach (but they are different)

if you seen a midline shift what does that mean

epidural hematoma

what comprises outer BRB

epith w/ TJ

where are tight junctions in BCSFB

epithelial and choroid plexus

where do you find epithelial

external surface of bodies and internal organs

what is the dural fold of a meninge

falx cerebri

is a epidural hematoma/hemmorhage fast or slow bleeding

fast

aqueous is where

fluid in the anterior chamber

where does middle meningeal artery enter skull

foramen spinosum

damage to internal cortical bridges leads where

great vein of galen

what are the possible symptoms of intracranial pressure

headaches, vomiting, nausea, pulsing sound, double vision because of increased cranial pressure

where are the dural venous sinuses

in dural fold of meninges of falx cerebri

how are they different?

in epidural (pterion hit, middle meningeal damage, midline shift, uncus,brainstem moves, parasym affected, CN3 impacted) but in subarach (due to aneurysm, PCOM affected)

is dural venous sinus is blocked what happens

increase in pressure and increase in CSF

if we see optic disc margins and axoplasmic stasis what does it sugggest

increased intracranial pressure and papilldema

what is meningitis

inflammation of meninges

where do you find endothelial cells

inside blood vessels

where is CSF produced (ventricles)

lateral, 3, and 4

where is choroid plexus present in (ventricles?)

lateral,3 and 4

if you have a subdural hematoma and headache that is due to

meningeal irritation of CN 5

what is the most important symptom of meningitis

neck stiffness

do every brain tumor cause increased brain pressure

no

does a unruptured aneurysm cause papildema

no

does every meningioma cause increased cranial pressure

no

does pituitary tumor cause increased pressure , or compress CSF

no

is subdural a real space usually

no

would damage to internal cortical bridges cause a subdural hematoma

no

can the subdural hematoma cross the midline , why

no dural fold

function of BBB

not allow solutes from blood to cross into fluid of CNS; prevent toxins from entering the brain

who does subdural hematoma typically occur in

older adults/ people on blood thinners

where is CSF located concerning the eyes

optic nerve sheath

meninges surround the optic nerve so we can have a

optic nerve sheath meningioma

what is an important eye finding of increased brain pressure

papilledema

what can cross BBB

passive diffusion/ selective transport (glucose, water,AAs)

what cannot cross BBB

pathogens, solutes in the blood, hydrophilic molecules into CSF

choroid plexus is highly vascularized

pia

where is CSF produces in vascularized....

pia/ choroid plexus

hematoma

pool of blood

where does middle meningeal artery become encased

pterion

where is middle meningeal artery encased on the external skull

pterion

where is outer BRB

retinal pigment epithelium

what does increased intracranial pressure mean

rise in pressure, inside the skull

what does a subdural hematoma usually result from

rupture of extern cortical bridging veins

what are hematomas or hemorrhages caused b

ruptured blood vessels

what symptoms does subdural hematoma have

same as epidural just slower

what are the symptoms of this

same as others

what happens if there is a ruptured aneurysm of posterior communicating artery

same things as above AND subarachnoid hemorrhage (papilldema)

how is blood CSF barrier similar to BBBB

selective diffusion, remove, prevent

blood csf barrier function

separate blood from getting into CSF

what if you see a child/infant with subdural hematoma

shaken baby syndrome (retinal hemorrhages)

is a subdural hematoma/hemmorhage fast or slow

slow

how can we check intracranial pressure

spinal tap or lumbar puncture cause CNS includes spinal cord

what lies superior to the temporal fossae and extends to the zygomatic arch

superior temporal line

what is papilledema

swelling of optic nerves in BOTH eyes

what is the opening for the brainstem

tentorial notch

if you get hit in the pterion what happens

the bone will rupture the middle meningeal and result in a epidural hematoma

if the middle meningeal artery causes a epidural hematoma then...

the temporal lobe will herniate over the tentorial margin

where does a meningioma invade our orbital cavity

through superior orbital fissure

what does a capillary have in the brain vs. in general

tight junction, pericytes, astrocytes, basal membrane

what is the function of the blood barriers

to protect the brain

where else is BBB found

transition from arterioles to venules

what causes epidural hematoma/hemmorhage

trauma

what causes subdural hematoma/hemmorhage

trauma

what is the most medial projection of the temporal lobe

uncus

where does subdural hematoma happen

under dura between arachnoid

what kind of blood is subdural hematoma/hemmorhage

venous

where does herniating brain move toward

weakest area/biggest openings: foramen magnum and tentorial notch (opening for brainstem)

when does the epidural become a real space

when there is bleeding

meningiomas are easier to see in MRIs with or without contrast

with!

who does this condition affect mainly

women of child bearing age or above ideal body weight

can a meningioma cause morbidity

yes

could there be a midline shift in subdural hematoma

yes

does a ruptured aneurysm cause papilledema

yes

is papilledema a medical emergency

yes

is an arterial bleed quick? if so, why?

yes under high pressure

can increased brain pressure be life threatening

yes!!

do BCSFB and BBB have TJ

yes, both do

does a epidural hematoma cross the midline

yes, but doesnt often

can a subdural hematoma be fatal

yes, but slower

can we have meningioma of falx cerebri

yes, compresses DVS and causes papilledema

is there meninges in the orbit

yes, optic nerve from dura inner layer (meningeal)

is there CSF around optic nerve

yes, subarachnoid space


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