-
medical term for "brain"
encephalon
-
medical term for "spinal cord"
medula spinalis
-
the outer portion of the brain:
gray matter (cortex)
-
the inner portion of the brain:
white matter
-
the three divisions of the brain:
- cerebrum (telencephalon, largest part)
- cerebellum
- brain stem (continuous with spinal cord)
-
- A. cerebrum
- B. diencephalon (thalamus & hypothalamus)
- C. midbrain (mesencephalon)
- D. spinal cord
- E. pons
- F. medulla oblongata
- G. cerebellum
-
divides the cerebrum into right and left hemispheres:
longitudinal fissure
-
a double fold of duramatter that connects to the crista gali:
falx cerebri
-
stem-like portion that joins the cerebrum to the pons and cerebellum:
midbrain
-
-
parts of the midbrain:
- diencephalon
- brain stem
- pons
- medulla oblongata
-
parts of the hindbrain:
- pons
- medulla oblongata
- cerebellum
-
composed of structures located near the midline of the brain:
- diencephalon
- (includes thalamus & hypothalamus)
-
nerve fiber that connects the right and left hemisphere:
corpus callosum
-
an endocrine gland located in the hypophyseal fossa of the sella turcica:
hypophysis cerebri (pituitary gland)
-
the third ventricle is surrounded by:
the cerebral hemispheres
-
inferior to the diencephalon is the:
hypophysis cerebri (pituitary gland)
-
largest part of the hindbrain:
cerebellum
-
median constricted area that seperates the
hemispheres of the cerebellum:
vermis
-
separates cerebellum from cerebrum:
transverse cleft
-
describe the appearance of the cerebellum:
a laminated appearance due to the many transverse fissures
-
tissue between the fissures of the cerebellum:
folia
-
upper position of hindbrain where the cerebrum, cerebellum, and medulla come together:
pons
-
Between the pons and spinal cord, the lower portion of the hindbrain:
medulla
-
the inner portion of the spinal cord:
a gray cellular substance
-
the outer portion of the spinal cord:
a white fibrous substance
-
- A. gray cellular substance
- B. white fibrous substance
- C. posterior nerve root
- D. anterior nerve root
- E. pons
- F. medulla oblongata
- G. spinal cord
- H. conus medullaris
- I. cauda equina
-
at what vertebral level does the spinal cord end?
around L1-L2 interspace
-
the spinal cord connects to the medulla oblongata at the level of:
the foramen magnum (great hole)
-
the pointed area where the spinal cord ends:
conus medullaris
-
a fibrous strand that extends from the conus medullaris and attaches the cord to the upper coccygeal segment:
filum terminale
-
there are _______ pairs of spinal nerves, and each pair arises from:
- 31
- two roots at the side of the spinal cord
-
where the nerves extend inferiorly through the vertebral canal below the termination of the spinal cord:
cauda equina
-
protective membranes that cover the brain and spinal cord:
meninges
-
the highly vascular inner sheath that adheres closely to the underlying brain and cord structures:
pia
-
the delicate, avascular central sheath that resembles a spider web:
arachnoid
-
the outermost, fibrous protective sheath of the spinal cord:
dura
-
nicknames for the pia and the dura meninges:
- pia - tender mother
- dura - hard or tough mother
-
the epidural space is between:
the subdural space is between:
the subarachnoid is between:
- epidural: between the periosteum of the bone and the duramatter
- subdural: between the dural and the arachnoid
- subarachnoid: between the arachnoid and the pia
-
- A. spinal cord
- B. pia mater
- C. subarachnoid space
- D. arachnoid mater
- E. dura mater
- F. vertebra
-
widened areas of the subarachnoid space:
cisternae
-
the widest space of the subarachnoid space:
cisternae cerebellomedularis (cisterna magna)
-
describe the shape and location of the cisternae cerebellomedularis (cisterna magna):
triangular in shape and at posterior–superior part of subarachnoid space between the base of cerebellum and dorsal surface of the medulla oblongata
-
the ______________ is continuous with the ventricles.
subarachnoid space
-
the subarachnoid space communicates with the ventricles by way of the:
median aperture and lateral aperture
-
- A. subarachnoid space
- B. fourth ventricle
- C. medulla oblongata
- D. lateral ventricle
- E. third ventricle
- F. cerebellum
- G. cisterna cerebellomedularis
- H. median aperture
-
alternate names for the median aperture and the lateral aperture:
- median aperture: foramen of magendie
- lateral aperture: foramen of lusckka
-
where are the median and lateral apertures located?
between the cisterna magna and the fourth ventricle
-
where is cerebrospinal fluid contained?
in the ventricles of the brain and the subarachnoid space
-
an area they sometimes stick to enter the subarachnoid space:
cisterna magna
-
fibrous membrane that covers bones except at articular surfaces:
periosteum
-
two spaces that do not communicate with the ventricular system and are potential sites of hemorrhaging:
-
the __________ space has a thin film of fluid, and the ___________ space is wider and filled with CSF.
-
results from bleeding between the dura and the skull, usually caused by tearing of the middle menigeal artery in the temporal region:
- epidural (extradural) hematoma
- signs of trouble usually arise within a few hours of injury, when the person loses consciousness after a brief period of responsiveness
-
results from bleeding that develops between the dura and the arachnoid:
subdural hematoma
-
which hematoma is more often a slow bleed from a tear in a vein?
subdural hematoma
-
a chronic subdural hematoma may occur in what type of patient?
an elderly person, in whom brain atrophy allows more space for a hematoma to develop
-
a tear in the arachnoid can:
it can allow CSF to leak into the subdural space creating additional pressure
-
name the two layers of the dura at cranial level:
- endosteal (outer)
- meningeal (inner)
-
the endosteal and meningeal layers of the dura are fused together, except for spaces that are called __________ which are large venous blood channels.
venous sinuses
-
lines the cranial bones, serving as periosteum to their inner surface:
the endosteal layer of the dura
-
protects the brain, supports blood vessels, and has four partitions (for support and protection of various parts of the brain):
the meningeal layer of the dura
-
list the four divisions of the meningeal layer of the dura:
- falx cerebri
- falx cerebelli
- right and left tentorium cerebelli
- sellar diaphragm
-
runs through the interhemispheric fissure and provides support for the cerebral hemispheres:
falx cerebri
-
seperates the cerebrum from the cerebellum:
right and left tentorium cerebelli
-
lower portion of the dura mater:
dural sac
-
dura extends below the spinal cord to the level of:
the 2nd sacral segment
-
what structures create CSF?
choroid plexuses
-
a water cushion protecting the brain and spinal cord from physical injury:
CSF (cerebrospinal fluid)
-
the ventricles all contain:
CSF
-
located on each side of the MSP in the inferior and medial part of the cerebal hemispheres:
right and left lateral ventricles
-
- A. anterior horn
- B. body of lateral ventricle
- C. third ventricle
- D. posterior horn
- E. fourth ventricle
- F. inferior horn
- G. interventricular foramen (foramen of monro)
-
give the names of the central, anterior, posterior,and inferior portions of the right and left lateral ventricles:
- central portion: body
- anterior: frontal horn
- posterior: occipital horn
- inferior: temporal horn
-
each lateral ventricle is connected to the third ventricle by a channel called the:
- interventricular foramen
- (aka foramen of monro)
-
describe the appearance of the 3rd ventricle:
a slitlike cavity that is somewhat quadrilateral in shape
-
the 3rd ventricle also connects posteroinferiorly with the 4th ventricle by means of a passage known as:
- the cerebral aqueduct
- (aka aqueduct of sylvius)
-
diamond shaped cavity of the hindbrain that lies anterior to the cerebellum and posterior to the pons and upper portion of the medulla:
4th ventricle
-
the pointed end of the 4th ventricle is continuous with the:
central canal of the medulla oblongata
-
the 4th ventricle communicates with the __________ via median and lateral apertures.
subarachnoid space
-
radiologic examination of the central nervous system structures within the vertebral canal such as the spinal cord and its nerve root branches:
myelography
-
what occurs during a myelogram?
contrast is put into the subarachnoid space (only) by spinal puncture and the spinal cord and nerve roots are outlined by injecting contrast
-
pathologies visualized with myelography (6):
- herniated disk
- bone fragments
- tumor
- cysts
- spinal cord swelling from an injury
- narrowing of subarachnoid space
-
name the two areas of puncture for myelography:
- L2-3 or L3-4 interspace (much more common)
- cisterna cerebellomedullaris
-
contrast used to better visualize nerve root branches:
- water-soluble
- (dense contrast can cover up anatomy)
-
give the history of contrast usage on myelograms:
- first used: pantopaque (oily, nonwater soluble contrast)
- in the 70s: metrizamide (water soluble contrast absorbed very fast by the body)
- today: non-ionic
-
list the non-ionic agents used in myelography:
- iohexol (ex. omnipaque)
- iopamidol
- ioversol
-
how is the contrast for a myelogram commonly administered?
- intrathecal injection into the subarachnoid space of L3-L4 or L4-L5.
- (since the cord ends at L1-L2, and you don’t want to stick cord)
-
describe water-soluble vs. oil-based contrast in terms of how much is needed in myelogram procedures:
- C & L spine: 9-12cc of w-s and 12-15cc of o-b
- T spine: 12cc w-s and 25-30cc o-b
-
contrast is in the ______ on post myelogram studies.
thecal sac
-
though rarely used, negative agents for a myelogram are:
-
how do positive and negative contrast movements differ in a myelogram?
- gas and opaque contrasts move in opposite directions
- air rises
- opaque dye moves down
-
name some contraindications for a myelogram:
- blood in the cerebrospinal fluid
- arachnoiditis
- increased intracranial pressure
- previous LP performed within two weeks (risk of extravasation of contrast)
-
name some things that should be done when prepping for a myelogram procedure:
- explain the details of the myelogram to the patient
- consent form
- one hour before exam, a sedative is given if needed
- patient needs to be well hydrated
- use aseptic technique
-
during a myelogram, what must be done when the patient is in the trendelenburg position and why?
- head extended
- compresses the cisterna magna and keeps contrast from flowing into the head
-
be familiar with the injection process to the lumbar area:
- dr fluoros and marks the center location on the back of the pt
- after marking site, pt is put in position for puncture
- pt is prone with pillow under stomach or lateral with spine flexed
- shave area
- clean skin with antiseptic solution
- dry area with gauze pad and drape
- local anesthetic is given with the 2cc syringe and 22 or 23 gauge needle
- spinal needle is inserted through skin into subarachnoid space
-
be familiar with the myelogram process after needle is placed:
- if needle is in place, CSF will flow back through needle
- a sample can be taken and sent to the lab
- CSF should be allowed to flow back and not drawn out
- contrast is now administered in an amount equal to the amount of CSF taken out
-
be familiar with the myelogram process after the contrast is administered:
- after the injection, the spinal needle is removed
- as the column of contrast medium travels through the spinal column, it is observed fluoroscopically
- the direction of its flow is controlled by varying the angulation of the table
- spot radiographs are taken at the level of any blockage or distortion in the outline of the contrast column
-
be familiar with the injection process to the cervical area:
- pt can be seated or prone with head flexed to place the external occipital protuberance in line with the spinous processes
- shave area
- clean skin with antiseptic solution
- dry area with gauze pad and drape
- local anesthetic is given with the 2cc syringe and 22 or 23 gauge needle
- spinal needle is inserted through skin into cisterna magna
- when needle is in place, position table to prevent media from entering ventricular system
- remove needle and extend neck to compress cisternal cavity
-
list some qualities of water-soluble media used today for myelograms that make it desirable:
- mixes well with CSF
- absorbed easily
- non-toxic
- inert (non-reactive)
- good radiopacity
-
positioning used for projections taken during a myelogram procedure:
- prone or supine
- anterior or posterior obliques
- pt. moved from trendelenburg to erect to help flow of contrast move throughout canal
- (for oil-based contrast, only prone positions were possible due to the needle remaining)
-
for a myelogram, crosstable lateral radiographs are obtained with:
- grid-front cassettes or a stationary grid
- must be closely collimated
-
a rapid, noninvasive form of radiography that produces sectional images and was first introduced in the 70s:
CT
-
for a CT head, what alignment is used?
axial orientation: gantry angle 20-25 degrees to the OML
-
what is best viewed on a coronal orientation for a CT head?
- sella turcica
- facial bones
- sinuses
-
describe the slices taken during a CT head:
- lowest slice: upper cervical/foramen magnum and the roof of the orbits are seen (posterior fossa)
- 12-14 slices taken
- slice thickness may vary: typically 8-10mm with 3-5mm slices through the posterior fossa
-
name pathologies viewed on a pre-infusion CT head (4):
- assessment of dementia
- craniocerebral trauma
- hydrocephalus
- infarcts
-
name pathologies viewed on a post-infusion CT head (6):
- primary neoplasms
- metastatic disease
- arteriovenous malformations (AVM)
- multiple sclerosis
- seizure disorders
- bilateral isodense hematomas
-
what is CT most useful for demonstrating (9)?
- size, location, and configuration of mass lesions
- surrounding edema
- cerebral ventricular or cortical sulcus enlargement
- shifting of ML structures
- hematomas
- aneurysms
- ischemic or hemorrhagic strokes
- acute infarcts
- trauma situations (contusions, subarachnoid hemorrhage, fracture evaluation)
-
in a CT head, how do an ischemic and a hemorrhagic stroke appear different?
- ischemic stroke appears to be a dark area
- hemorrhagic stroke appears to be a white area
-
what is a CT spine useful for?
- vertebral column hemangiomas
- lumbar spinal stenosis
- r/o fractures of cervical spine, especially for axis, atlas, and lower cervical and upper thoracic
- distinguish neural compression by soft tissue from compression by bone
- postoperatively, to assess surgical procedure
-
the myelographic procedure is usually followed by:
- a CT exam of the spine
- (within four hours, preferably within one)
- (generally limited to specific regions of the spine and performed while contrast agent is still within subarachnoid space)
-
be familiar with the specifics of a CT Myelography (CTM):
- 1.5 – 3 mm slices
- gantry parallel to the plane of the intervertebral disk
- demonstrates size, shape, and position of the spinal cord and nerve roots
- useful with compressive injuries or in determining the extent of dural tears resulting in extravasation of the CSF
-
magnetic resonance imaging (MRI) is not a valuable tool for:
- osseous bone abnormalities of the skull
- intra-cerebral hematomas
- subarachnoid hemorrhage
-
name pathologies viewed by MRI:
- multiple sclerosis
- spinal cord compression
- paraspinal masses
- post-radiation therapy changes in spinal cord tumors
- metastatic disease
- herniated disks
- congenital anomalies of spine
- middle and posterior fossa abnormalities
- acoustic neuroma
- pituitary tumors
- primary and metastatic neoplasms
- hydrocephalus
- AVM
- brain atrophy
-
name contraindications to MRI:
- (related to the use of the magnetic field:)
- pacemakers
- ferromagnetic aneurysm clips
- metallic spinal fusion rods
-
what is the imaging modality of choice in the diagnosis of multiple sclerosis?
MRI
-
brain stem lesions as small as ___________ can be identified on thin-slice axial MRI images
3MM in diameter
-
used for brain and cervical area MRIs:
head coil
-
used in MRIs of the spine below the cervical area:
body coil, in combination with a surface coil
-
For MRIs, what contrast is used to enhance tumor visualization:
paramagnetic contrast such as, gadolinium
-
imaging protocols may include _________ weighted images.
T-1 and T-2
-
a noninvasive modality of radiology that began in 1980s that provides detail of the brain, spinal cord, intervertebral disks, and CSF within the subarachnoid space, but is blind to bone:
MRI (magnetic resonance imaging)
-
a radiographic procedure in which images are created by the response of loosely bound hydrogen atoms to the magnetic field:
MRI (magnetic resonance imaging)
-
angiography is used to:
- assess vascular supply to tumors
- demonstrate the relationship between a mass lesion and intra-cerebral vessels
- illustrate anomalies of a vessel (ex. anneurism, vascular occlusion)
-
be familiar with the process of an angiogram:
- a catheter is placed into the vascular system under fluoro, most commonly in the femoral artery
- the image intensifier must be designed to move around the patient so the patient does not have to move.
- after the catheter is in place, a nonionic water soluble contrast is injected into the vessels and rapid sequence images are obtained.
-
angiographic tubes need a minimum focal spot size of _______ for routine imaging and _______ for magnification.
- routine: 1.3mm
- magnification: .3mm
-
an angiographic procedure used to assess
vascular abnormalities within the CNS:
- arteriosclerosis
- arteriovenous malformations
- aneurysms
- subarachnoid hemorrhage
- transiet ischemic attacks
- certain intracerebral hematomas
- cerebral venous thrombosis
-
provides a pre-surgical road map and is also performed in combination with interventional techniques to assess the placement of devices before and after the procedures:
cerebral angiography
-
involves the placement of various coils, medications, filters, stents, or other devices to treat a particular problem or provide therapy, and one type involves the introduction of small spheres, coils, or other materials into vessels to occlude blood flow:
interventional radiology
-
embolization techniques are often performed to treat:
- AVMs
- aneurysms
- to decrease blood supply to various vascular tumors
-
used to open occluded vessels by the injection of specialized anticoagulant medications or by the inflation of small balloons within the vessel:
percutaneous angioplasty
-
an examination of individual intervertebral disks where an injection is made into the nucleus pulposis- using double needle entry and water-soluble contrast to diagnose
internal lesions within a disk for rupture of the nucleus pulposus which can not be demonstrated by myelography:
- diskography (aka nucleography)
- replaced by MRI and CTM
-
interventional procedures used to treat spinal compression fractures and other pathologies of the vertebral bodies that have not responded to treatment:
- vertebroplasty
- kyphoplasty
-
be familiar with the process of a percutaneous vertebroplasty:
- the injection of a radiopaque bone cement (polymethyl methacrylate) into a painful compression fracture under fluoro
- may be performed in the special procedures room or OR with sedation
- a specialized trocar needle is advanced into the fractured vertrebral body under fluoro
- intraosseous venography using nonionic contrast media is performed to confirm needle placement
- the cement is injected, stabilizing fracture fragments and leads to reduction in pain
- post injection radiographs (AP and lat spine and possible CT)
-
be familiar with the process of a kyphoplasty:
- a balloon catheter is used to expand the compressed vertebral body to near its original height before injection of the bone cement
- inflation of the balloon creates a pocket for the placement of cement
- can help restore spine to a more normal curvature and reduce hunchback deformities
-
what are the success rates and risks involved with both vertebroplasty and kyphoplasty:
- both procedure successes are measured by the reduction of pain reported by the pt
- success rates reported to be 80–90%
- risks to both procedures: leakage of the cement before it hardens, pulmonary embolism, and death (rare, but possible)
|
|