Unit 2 Central Nervous System
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(shows lighter on CT)
(shows darker on CT)
three major parts of the brain:
- brain stem
parts of the brain stem
- midbrain (mesencephalon)
components of midbrain
- stemlike portion that connects the cerebrum to the pons and cerebelum
- connects forebrain to hindbrain
components of hindbrain
- medulla oblongata
largest part of the brain.
longitudinal fissures (R&L hemispheres with ventricles)
contains hypothalamus and thalamus.
composed of structures located near midline of the brain
contains pituitary gland (inferiorly) (aka hypophysis cerebri)
largest part of hindbrain.
transverse sulci gives it a sauliflower look.
tissue b/w sulci or fissures of cerebellum
median constricted area the serperates the hemispheres of the cerebellum
seperates the cerebellum from cerebrum
the of the cerebrum divides it into right and left hemispheres
connects the cerebral hemisphere.
main nerve fiber of cerebrum.
each cerebrum hemisphere has a that contain CSF and surrounds the 3rd ventricle
slender, elongated structure.
inner part is a gray cellular substance. (shaped like "H" when cut transversely)
white fibrous substance surrounds the "H"
spinal cord connects to medulla oblongata at the level of
- foramen magnum
- "great whole"
spinal cord extends to the space of the
1st or 2nd lumbar vertebrae
the pointed area where the cord ends
fibrous strand that extends from the conus medullaris and attaches the cord to the upper coccygeal segment
pairs of spinal nerves are transmitted thru the intervertebral and sacral foramina
nerves below the termination of the spinal cord that extend inferiorly thru the vertebral canal
(resembles a horses tail)
lower portion of the dura that extends below the spinal cord to the level of S2 that encloses the cauda equina
protective membranes that cover brain and spinal cord
inner sheath "tender mother"
adheres closely to the underlying brain and cord structure
delicate central sheath
resembles a spider web
hard "tough mother"
fibrous outermost protective sheath of the spinal cord
adheres to bone
outer layer of dura
lines the cranial bones serving as periosteum
inner layer of dura
spaces for venous sinuses which are large venous blood vessels
b/w the dura and the vertebral periosteum
b/w dura and arachnoid
b/w arachnoid and pia
filled with CSF
communicates with ventricles
contained in the ventricles of the brain and the subarachnoid space.
water cushion protecting the brain and spinal cord from physical injury.
coats the spinal cord in nutrients.
CSF can increase and decrease with shrinking or expanding of
network of capillaries located in the ventricles
widened areas of the subarachnoid space.
filled with CSF
widest space of the subarachnoid space.
triangular in shape and at the post-sup part of the subarachnoid space b/w the base od the cerebellum and dorsal surface of the medulla oblongata
- certerna magna
- cisternae cerebellomedularis
allow communication fo the subarachnoid space and ventricles
foramen of magendie
foramen of lusckka
bleeding b/w dura and skull
bleeding b/w dura and arachnoid
four partitions of the dura
- falx cerebri
- R & L tentorium
- falx cerebelli
runs through the interhemispheric fissure and provides support for the cerebral hemispherers
seperates the occipital lobe of the cerebrum from the cerebellum
seperates the two cerebelli hemispheres
name the portions of the ventricles:
- body- central portion
- anterior- frontal horn
- posterior- occipital horn
- inferior- temporal horn
the 3rd ventricle is in shape while the 4th ventricle is in shape
the pointed end of the 4th ventricle is continuous with the
central canal of the medulla oblongata
connects each lateral ventricle to the 3rd ventricle
- interventricular foramen
- "foramen of monroe"
the 3rd ventricle also communicates with the 4th ventricle through the
cerebral aqueduct of "acqueduct of sylvius"
- lateral ventricles
- interventricular foramen
- 3rd ventricle
- acqueduct of sylvius
- 4th ventricle
- median and lateral aperatures (magendie and lyscka)
- cisternae magna
- remainder of aubarachnoid space
radiographic examination of the CNS structures within the vertebral canal such as spinal chord and nerve root branches
in myelography an intrathecal injection is made and contrast is put into the space and the spinal chord and nerve roots are outlined
- non ionic water soluble inert (non reactive)
what are the two areas that can be punctured for myelography
- L2-L3 or L3-L4 interspace
- cisterna cerebellomedullaris
name 3 non ionic agents used in myelography
- iohexol (omnipaque)
- iopamidol (isovue)
- ioversol (optiray)
how much contrast is used for c-spine myelography?
- C&L 9-12 cc's water soluble
- T 25-30 cc oil and 12 cc water soluble
contraindications to myelogram
- blood in the CSF
- increased intracranial pressure
- previous lumbar puncture performed within 2 weeks of current
steps to myelogram
- explain the details of the exam to the pt
- consent form
- 1 hour before exam, sedative is given
- pt should be well hydrated
- use aseptic technique
the head must be extended while the patient in the trendelenburg position to
prevent contrast from flowing into the ventricles
steps to cervical puncture myelography
- pt seated prone with head flexed to place the external occipital protuberence in line with the spinous processes
- shave area
- clean skin with antiseptic
- local anesthetic
- SPINAL NEEDLE INSERTED INTO CISTERNAE MAGNA
- when needle is inplace position table to prevent contrast from entering the ventricles
- remove needle and extend neck
centering for a cervical myelography
- vertical or horizontal ray may be used
- center to C5
routine images for lumbar myelography
- AP or PA
- x table with grid
- conus projections for conus medullaris:
- AP centered to T12 L1
images followed by CT
explain post myelogram patient care
- pt's head and shoulders elevated 30-45 degrees
- remain in recovery for 4-8 hours and rest for several hours
- plenty of fluids
- exam of the puncture site before departure
CT myelography is done to:
- done to visualize size, shape, and position of the spinal cord and nerve roots
- 1.5-3mm slices
radiologic examination of individual intervertebral disks
routine for a CT head
- gantry angle 20-25 degrees to OML
- lowest slice, upper cervical/foramen magnum and the roof of the orbits are seen.
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