Leptomeninges, Subarachnoid Space and Cisternae - Neuroanatomy 2

Overview

Teaching with the media such as video is brain friendly because it provides interactive abstract learning that utilizes the categorical memory and requires little intrinsic motivation.

Neuroanatomy is an integral part of human anatomy that is taught to medical students. This video preparation is an attempt to offer interactive learning of the practical aspect of neuroanatomy to medical students and prospective surgeons who are studying for higher degree in neuroanatomy.

 

This section focuses on the rest of the brain coverings following the removal of the brain. The video preparation shows practical demonstrations of arachnoid mater, pia mater and subarachnoid space. The clinical note section discusses the clinical correlation of these structures and the space.

It would be useful if students study the section on the removal of the brain and the gross anatomy of the related structures (Brain Dissection Practical Part 1) which had been previously published.


In order that students may self-test their understanding of the topics in relation to clinical practice, a case presentation and problem-based questions have been included at the end of the video. Should students wish to acquire further knowledge of the area, a list of reference publications has been included at the end of section.

Author(s): Dr. Casmiel K. OsabuteyView Details of Author
Year: 2013
Keywords: brain, anatomy, nueroanatomy, leptomeninges, arachnoid space, subarachnoid space, cisternae, human brain, brain removal, brain parts,
Licensing Condition:

cc-by-nc© 2013, KNUST

Unless otherwise noted, the content of this programme is licensed under the terms of a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Disclaimer

 

Any information and/or video demonstration in this material is intended to inform and to educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. You should speak to your lecturer, healthcare professional or lab technician and make an appointment, if you have questions or concerns about this information.

 

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Introduction

 

BRAIN DISSECTION PRATICAL - PART 2

LEPTOMENINGES, SUBARACHNOID SPACE AND CISTERNAE

The leptomeninge is a thin inner covering of the brain. It consists of

  1. Arachnoid mater
  2. Pia mater

The pia mater is very thin and intimately associated with the surface of the brain, dipping into the sulci. The arachnoid mater bridges over the various irregularities (Fig. 14). The space between the pia and arachnoid – subarachnoid space contains the CSF and are joined together by trabeculae. In certain areas the subarachnoid space widened to form cavities – subarachnoid cistern

 

Some important subarachnoid cisternae

  1. Cerebellomedullary cistern (cisterna magna) located between the cerebellum and medulla oblongata.
  2. Pontocerebellar cistern located at the angle between the Pons and cerebellum.
  3. Interpeduncular cistern located between two cerebral peduncles.
  4. Chiasmatic cistern located anterior and below the optic chiasma.
  5. Cisterna ambiens located on the side of the midbrain.
  6. Cisterna quadrigemina located at the dorsum of midbrian between the cerebellum and occipital lobe.
  7. Cistern of the lateral fossa, where the arachnoid bridge over the lateral sulcus.


latern fossa


Fig. 14. A photograph of the superior-lateral surface of the cerebral hemisphere demonstrating arachnoid mater

Note that it bridges the sulci (arrows). Identify the cistern of the lateral fossa.

 

Objectives

 

Appreciate the components of leptomeninges and differenciate between the arachnoid and pia mater.

Define the subarachnoid space and demonstrate the anatomical position of the subarachnoid cisternae.

Understand what is entailed in leptomeningitis and cisternal puncture.

 

Lesson Content


Demonstration of Arachnoid & Pia Mater (video)
Demonstration of Arachnoid & Pia Mater

 

Demonstration of subarachnoid space and subarachnoid cisternae (video
Demonstration of subarachnoid space and subarachnoid cisternae

 

Clinical Notes

Leptomeningitis (or Meningitis)

Meningitis is characterized by inflammation of the arachnoid–pia mater caused by bacteria or virus. Inflammation can spread into the ventricular system. The common complication is the formation of fibrous adhesion between the pia and the arachnoids which interferes with CSF circulation. Other complications include brain abscess, brain infarction, hydrocephalus, ventriculitis and dural sinus thrombosis.
The common complication of leptomeningitis in Ghana is senseroneural hearing loss and blindness (Hodgson et al 2001)

Cistern Puncture

A suboccipital puncture or cisternal puncture is a diagnostic procedure that can be performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or rarely to relieve increased intracranial pressure. It is done by inserting a needle through the skin below the external occipital protuberance into the cisterna magna (cerebellomedullary cistern) and is an alternative to lumbar puncture.

 

Self Assessment Quiz

 

CASE

On December 13, 2012, a 3-year old female child was taken to a local health centre with a complaint of pain in the left ear. The medical assistance in-charge of the health centre, upon examination, diagnosed Otitis Media and put the child on chloramphenicol eardrops and oral analgesic at the OPD. On December 16, 2012, at about 9:30am the child was sent back to the health center with complaints of headache, neck pain, fever and vomiting. On physical examination, she was found to be restless, febrile (temperature 38.90C) and had neck stiffness. The medical assistant considered meningitis and referred her to the district hospital. A lumbar puncture was performed; the CSF was cloudy, under pressure, WBC count was more than 6,000 cells and gram stain showed gram-positive diplococci.

 

The child was admitted into ICU and intravenous Ceftriaxone was administered immediately after the lumbar puncture. However, the child's condition deteriorated, she became comatose with Glasgow comma scale of about 10; she was eventually transferred to a tertiary care centre where subrachnoid bolt was placed. Intracranial pressure was found to be increased and ventriculoperitoneal shunt was done. With the appropriate supporting and antibiotics treatments, the child recovered but was left with deafness in the right ear, bilateral vestibular imbalances and the right eye deviated medially. 

 

Clinicoanatomical Questions

1. What is meningitis?
2. Why should otitis media cause meningitis?
3. Why should the child present with neck stiffness?
4. What is the cause of increased intracranial pressure in this patient?
5. Give account of the neurological sequelae of the meningitis that had occurred in this child.

 

Check the Answers to the Case questions.

 

References


    Hodgson, A. et al. (2001) Survival and sequelae of meningococcal meningitis in Ghana. Int. J. Epidemiol.  30 (6): 1440-1446
    Hoffman. O and Weber, JR (2009) Pathophysiology and treatment of bacterial meningitis. Ther Adv Neurol disord 2 (6): 401 – 412j

     

Credits

 

Author

dr osabutey

Dr. Casmiel K. Osabutey
Senior Lecturer
School of Medical Sciences
College of Health Sciences, KNUST
Kumasi, Ghana

Proof Reader

dakroful

Mr. David V.K. Arkorful
Librarian
Pharmacy Library
CHS - KNUST

Cinematography, Editing and Graphics

dnartey

Daniel V. Nartey

OER Technical Support

 

Benjamin Prempeh
OER Media Specialist
KNUST, Kumasi - Ghana
adobrog@yahoo.com

 

Post Production

icom

Ingenuity Complex Multimedia
Kumasi, Ghana
+233 24 386 9422

 

Acknowledgment

 

This programme was produced with support from the following:

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