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List the 3 layers of the meninges.

1. dura mater

2. Arachnoid mater

3. Pia mater


Which layer of the meninges is the outer most layer?

Dura mater—outermost meninx; has 4 folds; lines the periosteum of the skull and protected the brain; subdural space separates this from the arachnoid mater


What layer of the meninges is the inner most layer?

Pia mater—innermost meninx; covers the contours of the brain; forms the choroid plexus in the ventricular system


What is the middle layer of the meninges?

Arachnoid mater—middle meninx; the arachnid is impermeable; surrounds the brain in a loose manner; subarachnoid space separates this form the pia mater


What separates the arachnoid mater from the pia mater?

The subarachnoid space


What is meningitis?

Inflammation of the meninges of the brain and spinal cord. Many forms of meningitis but with bacterial meningitis being potential fatal within hours of onset it is important for a PT to recognize the s+s of acute meningitis.


What are the signs and symptoms of meningitis?

1. Fever, headache, vomiting
2. Complaints of a stiff and painful neck, unchallenged rigidity
3. Pain in the lumbar area and posterior thigh
4. Brudzinski’s sign (flexion of the Neck facilitates flexion fo the hips and knees )
5. Kernig’s sign (pain with hip flexion combined with knee extension)
6. Sensitivity to light

*Early dx is important to avoid neurological damage


What is the gold standard for the diagnosis of meningitis?

Lumbar puncture


Name the dural spaces.

1. Epidural space

2. Subdural space

3. subarachnoid space


Where is the epidural space located?

—An area b/t the skull and outer dura mater that can be abnormally occupied

—also the area in the spinal cord b/t the dura mater and the periosteum of the vertebrae


Where is the subdural space located?

The area b/t the dura and arachnoid meninges


Where is the subarachnoid space located?

Area b/t the arachnoid and pia mater that contains CSF and the Circulatory system for the cerebral cortex


What is the purpose and design of the ventricular system?

Designed to protect and nourish the brain


what is the ventricular system comprised of?

Four fluid filled cavities known as ventricles and multiple foramina which allow passage of CSF.


What does each ventricle contain?

Specialized tissue known as choroid plexus which makes the CSF


What can an excessive amount of CSF in the brain cause?

Enlargement in the ventricles causing hydrocephalus; excess fluid within the spinal cord is term syringomyelia


What is the purpose of CSF?

Cushions the brain and spinal cord from injury and provides mechanical buoyancy and support.

Serves as a conduit for removal of metabolites and is constantly being absorbed and replenished within the brain and spinal cord


How much CSF is yielded per day?

500-700 ml/day


What does the blood brain Barrier consist of?

1. meninges

2. protective glial cels

3. Capillary beds of the brain


What is the blood-brain barrier responsible for?

Exchange of nutrients b/t the CNS and the vascular system. This provides protection for the CNS by restricting certain molecules from crossing the barrier while others are still able to do so freely


Where is the largest amount of gray matter found in the spinal cord?

Lumbar region


What arteries supply the spinal cord?

Vertebral Arteries form the anterior spinal artery and 2 posterior arteries


The spinal cord runs from __________ to ____________.

Foramen magnum to conus medullaries (between the 1st and 2nd Lumbar spine)


Where does the spinal cord end?



T or F: each spinal nerve contains a dorsal root (sensory) with afferent fibers and a ventral root (motor) with efferent fibers



What is hydrocephalus?

Increase in CSF within the ventricles of the brain typically due to poor resorption, obstruction or flow or excessive production of CSF.


What can hydrocephalus be classified as?






What are signs of hydrocephalus or a blocked shunt?

1. Enlarged head or bulging fotanelles in infants
2. Headache
3. Changes in vision
4. Large veins noted on scalp
5. Seizures
6. Behavior changes
7. Alteration in appetite, vomiting
8. “Sun setting” sign or downward deviation fo the ease
9.. incontinece


What is an UMN disease characterized by?

A lesion found in the DESCENDING motor tracts within the cerebral cortex, internal capsule, brainstem, or spinal cord.


What are symptoms of a UMN lesion?

-weakness of involved muscles
-mild disuse atrophy
-abnormal reflexes