Материал: Kaplan USMLE-1 (2013) - Anatomy

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Section Ill • Gross Anatomy

Names of the Major Dural Sinuses

1 . Superior sagittal*

2.Inferior sagittal

3.Straight*

4.Transverse* (2)

5.Sigmoid (2)

6.Cavernous (2)

7.Superior petrosal (2)

* Drain into the confluence of sinuses located at the inion.

Folds (Duplications) of Dura Mater

A.Faix Cerebri

B.Tentorium Cerebelli

Figure 111-6-1 2. Dural Venous Sinuses

Major dural venous sinuses

The major dural venous sinuses are the following (Figure III-6- 12):

•The superior sagittal sinus is located in the midsagittal plane along the superior aspect of the falx cerebri. It drains primarily into the conflu­ ence of the sinuses.

•The inferior sagittal sinus is located in the midsagittal plane near the inferior margin of the falx cerebri. It terminates by joining with the great cerebral vein (of Galen) to form the straight sinus at the junction of the falx cerebri and tentorium cerebelli.

•The straight sinus is formed by the union of the inferior sagittal sinus and the great cerebral vein. It usually terminates by draining into the confluens of sinuses (or into the transverse sinus) .

•The occipital sinus is a small sinus found in the posterior border of the tentorium cerebelli. It drains into the confluens of sinuses.

•The confluens ofsinuses is formed by the union of the superior sagittal,

straight, and occipital sinuses posteriorly at the occipital bone. It drains laterally into the 2 transverse sinuses.

•The transversesinuses are paired sinuses in the tentorium cerebelli and attached to the occipital bone that drain venous blood from the confluens of sinuses into the sigmoid sinuses.

•The sigmoidsinuses are paired and form a S-shaped channel in the floor of the posterior cranial fossa. The sigmoid sinus drains into the internal jugularvein at the jugular foramen.

•The paired cavernous sinuses are located on either side of the body of the sphenoid bone (Figure III-6- 1 3) .

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Section Ill • Gross Anatomy

INTRACRANIAL HEMORRHAGE

Epidural Hematoma

An epiduralhematoma (Figure III-6- 14A) results from trauma to the lateral aspect of the skull which lacerates the middle meningeal artery. Arterial hemorrhage occurs rapidly in the epidural space between the periosteal dura and the skull.

•Epidural hemorrhage forms a lens-shaped (biconvex) hematoma at the lateral hemisphere.

•Epidural hematoma is associated with a momentary loss of conscious­ ness followed by a lucid (asymptomatic) period of up to 48 hours.

•Patients then develop symptoms of elevated intracranial pressure such as headache, nausea, and vomiting, combined with neurological signs such as hemiparesis.

•Herniation of the temporal lobe, coma, and death may occur rapidly if the arterial blood is not evacuated.

Subdural Hematoma

A subdural hematoma (Figure III-6- 14B) results from head trauma that tears superficial ("bridging") cerebral veins at the point where they enter the superior sagittal sinus. A subdural hemorrhage occurs between the meningeal dura and the arachnoid.

•Subdural hemorrhage forms a crescent-shaped hematoma at the lateral hemisphere.

•Large subdural hematomas result in signs of elevated intracranial pres­ sure such as headache and nausea.

•Small or chronic hematomas are often seen in elderly or chronic alco­ holic patients.

•Over time, herniation of the temporal lobe, coma, and death may result if the venous blood is not evacuated.

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