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Clinical correlates
Clinical correlates
Skin
Connective tissue (sub. cut. tissue): vessels/nn
Aponeurosis, epicranial see next slide
Loose connective tissue to allow movement of 1st 3 layers
Pericranium (periostium) tissue lining bone
Clinical correlate
Scalp proper
Epicranial aponeurosis
Occipitofrontalis m
A m of facial expression, e.g.
frontal belly wrinkles forehead &
-elevates eyelids I cant believe that
Occipital belly smoothes
Occipital belly
Frontal belly
forehead skin
Occipitofrontalis m
CN VII facial n
FYI: other mm attach to the
-innervates both bellies
epicranial aponeurosis, e.g.,
superior auricular m, which
elevates the auricle (external ear)
Supraorbital a.
Supraorbital a.
Supratrochlear a.
Superficial temporal a.
Supratrochlear a.
Occipital a.
Superficial temporal a.
Occipital a.
Clinical correlate
Scalp lacerations
Most common head laceration requiring surgery
FYI. Hair apposition
technique w/ tissue
glue for superficial,
non-bleeding wound
http://www.aafp.org/afp/2008/1015/p945.html
Emissary v.
They drain into Dural sinus: part
of the venous drainage system
of brain; discussed later
Diploic v.
10
Emissary v. foramina
(present in various
skull bones)
posterior
11
Epicranial aponeurosis:
scalp danger zone
Clinical correlates
Scalp
epicranial
aponeurosis
Superficial v
Diploic v
Emissary v
Emissary v
Dural sinus
13
Clinical correlate
Scalp blood can drain into loose connective tissue of eyelids/root nose
Black eye: local periorbital bleed; occurs w/in hrs post trauma
Raccoon eyes:
14
http://en.wikipedia.org/wiki/Black_eye
Local periorbital
subcutaneous
hematoma due to bleed
from facial trauma
Bilateral subcutaneous
hematoma due to
bleed from basilar
skull fracture
http://hgimg.com/bookimages/5/2461.1.jpg
15
Scalp lacerations
Clinical correlates
16
17
Lesser
wing
CN III/IV/V1/VI:*
superior orbital
fissure count
Greater wing
18
CN IX/X/XI:* jugular
foramen on post. lower
face of petrous; count
CN XII hypoglossal:
hypoglossal canal in
occipital bone
19
IX/X/XI
III
IV hard
Hypophyseal to see
fossa
VI
VII/VIII
II
III
XII
VI
VII/VIII
XII
cord
II
clivus
Middle
cranial
fossa
IV hard
to see
eye
IX/X/XI
Crista galli
eye
20
Aneurysm here
Internal
carotid a
cerebral
segment
Clinical correlate
IX/X/XI
eye
CN II
III
III
Hypophyseal
fossa
V
VI
VII/VIII
XII
Internal
carotid a
CN II
Crista galli
CN II optic n: near
cerebral part of internal
carotid a
eye
cord
21
Clivus:
mostly
made from
basilar part
of occipital
bone*
*AKA
basiocciput
brain
stem
Hemisected head
Squamous (plate-like)
part of Occipital bone
10 CNs
connect
w/
Allbrainstem
but CNs
CN I olfactory,
& XI spinal
acc
Dotted line:
foramen
magnum
22
23
Tuff mother:
Dura mater
Superficial/outer layer
Adheres directly to inside surface of cranial vault
Spider mother:
Arachnoid mater
Intermediate
Tender mother:
Pia mater
Deepest
Adheres directly to brain/cord
eye
Crista galli
Middle
cranial
fossa e.g., dura
lining basal
Hypophyseal
surface
of
fossa
posterior
cranial fossa
clivus
Dura: adheres to
the inside surface
of the cranial vault
eye
cord
25
Basilar skull
Posterior
26
pia
Brr of middle
meningeal a
Anterior
Lateral view
of brain w/
part of dura
removed
Posterior
Arachnoid mater (clear
shinny membrane)
over vessels/CSF,
which are deep
Wooden applicator in subdural space
between dura & arachnoid
28
1
http://www.fda.gov/MedicalDevices/Safety/AlertsandNo
http://medgadget.com/2005/04/duraseal.htm l
Dural repair
29
FYI gyri
FY
I
Po
st ce
ntr
al
gy
rus
FYI Pre
-
central
g
yrus
30
pia
Spinal Cord
Clinical correlates
(i.e., Fx of base of
CSF otorrhea
CSF leaks out of ear
Following head injury via
Basal skull Fx of petrous part temporal bone
Ruptured ear drum also needed for CSF to leak out of ear
32
3 Dural reflections
#1. Falx cerebri: R/L cerebral
hemispheres drops down from
cranial dura like a curtain
Anterior attachment of
falx cerebri: crista galli
of ethmoid bone not seen
33
Superior view
of cranial
vault
#3. Diaphragma
sellae: separates
pituitary from brain
34
clivus
pituitary
Crista galli
Diaphragma sellae
eye line:
Dotted
eye
Diaphragma sellae
separating pituitary
Middlefrom brain
cranial
fossa
cord
35
Other views
Falx cerebri
cerebellum
Tentorium
cerebelli
Hemisected head
36
Falx cerebri
Tentorium cerebelli running
down hill
37
38
Dural sinuses
Dural sinus
39
40
Dural sinuses
Superior sagittal sinus; in
upper part of falx cerebri
Falx cerebri
41
Cavernous sinus
-near pituitary gland
FYI: superior petrosal
sinus: top of petrous ridge
Straight
sinus in
tentorium
cerebelli
pituitary
42
Posterior
view of brain
Green wire traveling in
opened superior
sagittal sinus on top of
falx cerebri
Confluence of sinuses
Transverse Sinus
Sigmoid Sinus
angiogram
Internal jugular v
45
Cavernous sinus
-near pituitary gland
The unusual
instance of an
artery inside a
venous
system
O TOM CAS
46
Cavernous sinus:
Internal carotid a & CNs 3,4,51,52,6 count
Superior view of the middle cranial fossa
Orange: V2 heading
for foramen rotundum
Sella turcica
clivus
Cavernous
sinus also has
ophthalmic vv
draining into it
from orbit
Clinical correlate
47
ICA*
ICA*
white box
III
III
not seen-IV
V1/2 VI
VI
Black circle:
hypophyseal fossa
Middle
fossa
clivus
Cavernous
sinus
II
II
48
Interconnects various
sinuses
Also interconnects w/
internal vertebral
venous plexus of spine
Clinical correlates
Allows spread of
metastases &
infections between
brain/spine/trunk
Sits on clivus
49
Epidural fat
posterior
Internal vertebral
venous plexus
allows malignancy/
infection spread
between
trunk/spine/brain
Dura mater
anterior
Internal vertebral venous plexus (of Batson):
in cord
epidural
Epidural fat
space
50
51
Internal carotid a
Br common carotid a
Most strokes
FYI L. subclavian a
Vertebral aa
Vertebral-basilar system
Internal carotid a
52
Cerebral seg
Cavernous seg.
Petrous seg. That part inside carotid
canal, which is in petrous part of temp bone
53
Slide 4
Internal carotid
artery
segments. AP
MRA (magnetic
resonance
angiogram).
Cerebral
seg.
Cavernous
seg.
Petrous
seg.
Cervical seg.
Vertebral aa
III
III
V
VII VI
VIII
IX
X
XI
clivus
Posterior view
of clivus
VI
XII
dotted lines
55
Slide 4
ICA
ICA
Basilar a
Vertebral aa
Vertebral artery.
AP MRA
(magnetic
resonance
angiogram)
Does not capture
stationary tissue
Klioze SD. The
Brain. Dept. of
Anatomy &
Neurobiology &
Dept. Radiology,
EVMS
56
Middle
meningeal a
Clinical correlate
Q: A Fx of the
pterion will
rupture what a.
& cause what
kind of bleed?
A: ant. br
middle
meningeal a;
epidural bleed
Medial view
Anterior br of middle
meningeal artery is
deep to Pterion
H encircled in black
Posterior br
of middle
meningeal a
Middle
meningeal a
Maxillary a
External
carotid a
http://www.unifesp.br/dneuro/neu
rociencias/229_revisao.pdf
http://www.medscape.com/viewarticle/472974_458
Middle meningeal a
Enters cranial vault via
foramen spinosum in
greater wing of sphenoid
Foramen ovale
Pe
tem trou
p b s pa
on rt
Foramen
e
Indentation
made by post br
of middle
meningeal a
magnum
Basilar skull
Posterior
Anterior
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60