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Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The falx cerebri is located within the longitudinal fissure separating the left and right cerebral hemispheres. Inferiorly, it is attached to the crista galli and the internal occipital crest of the inner surface of the occipital bone. Both the superior and inferior sagittal venous sinuses lie within the falx cerebri. Its posterior margin is continuous with the tentorium cerebelli, which separates the cerebellar hemispheres from the cerebrum, but is at right angles to the falx cerebri. The transverse sinus is located within the tentorium cerebelli. Finally, the falx cerebelli separates the two cerebellar hemispheres in the midline but inferior to the tentorium cerebelli (Figure 1.3).
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
At this stage, be very careful not to allow stretching of the cerebral peduncles. Removal of the brain is facilitated with the neck in hyperflexion; therefore, rest the head on a firm, elevated support. Cranial nerves VII, VIII, IX, XI, and XII are the next structures to be divided, but prior to their isolation, describe their position and course in situ. The vertebral arteries are described and divided in the same fashion (Figure 2.131b). Last, the cervical portion of the spinal cord is transacted. It is easier to insert the scalpel blade if the brainstem is slightly stretched (Figure 2.131c). If a critical lesion is identified, a section should be taken, then cut transversely across the area. The cerebral peduncles are exposed by gentle force, pushing the brain backward with the hands. They are then extracted from the cranial vault, along with the brainstem. Care should be taken to avoid excessive stretching of the upper portions of the cervical cord. The lateral portions of the tentorium are incised close to the petrosal bone freeing the brain, which can then be lifted out. A detailed examination of the cranial skullcap and the cranial cavities, and a proper photographic record are carried out (Figure 2.132).
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
Why does the pupil dilate in raised intracranial pressure (ICP)?The oculomotor nerve is pushed against the free edge of the tentorium by a haematoma or brain swellingThis is a sign of impending tentorial herniation (coning)In some cases the opposite pupil can be dilated (false localising sign)
The rare manifestations in tuberculous meningoencephalitis: a review of available literature
Published in Annals of Medicine, 2023
Rong li He, Yun Liu, Quanhui Tan, Lan Wang
Continuously increased brain pressure is prone to brain hernia, mainly tentorial hernia, axial hernia and foramen magnum hernia [1]. In the late stage of the brain nodule, when the arachnoid membrane of the skull base is widely adhered or the tuberculous inflammation directly invades the nerve, cranial nerve paralysis will occur. Tuberculous spinal meningitis and arachnoiditis, formation of intramedullary granuloma or tuberculous fibrous exudate around the spinal cord and nerve root, often lead to paraplegia, dysuria and nerve root pain. Tuberculous vasculitis throughout the course of the disease is prone to large vessel occlusion, leading to cerebral infarction, tuberculous granuloma and tuberculous abscess compressing brain parenchyma, as well as hemiplegia, such as simultaneous aphasia of dominant hemisphere.
Extrapulmonary tuberculosis
Published in Expert Review of Respiratory Medicine, 2021
Surendra K Sharma, Alladi Mohan, Mikashmi Kohli
In TB endemic areas, TBM is predominantly a disease of children and adolescents, but is increasingly being seen in adults as well. The onset is subacute over 2–6 weeks; rarely acute onset has also been described. In the prodromal phase, which may last for 2–3 weeks, vague ill-health, irritability, apathy, loss of appetite, and behavioral changes have been noted. With the onset of meningitis, the classical symptoms of fever, headache and vomiting, focal neurological deficits, and features of raised intracranial tension manifest. Seizures that may be focal or generalized, cranial nerve palsies (the sixth cranial nerve involvement being the most common) are often seen. Complete or partial loss of vision can develop as a complication of TBM and is the result of opticochiasmatic arachnoiditis. Ependymitis, vasculitis with inflammation, spasm, constriction, and thrombosis may cause infarcts that usually occur in the territory of the middle cerebral artery causing hemiparesis. Increasing hydrocephalus and tentorial herniation are heralded by progressive deterioration in the level of consciousness, pupillary abnormalities, and pyramidal signs. Deep coma and decerebrate or decorticate posturing may then develop. Untreated, patients with TBM die in 5–8 weeks time [15,16]. Uncommon clinical presentations such as acute meningitic syndrome, status epilepticus, stroke syndrome, locked-in-state, trigeminal neuralgia, infantile spasm, and movement disorders, progressive dementia, psychosis have been reported [2,3].
Anatomic variations of the human falx cerebelli and its association with occipital venous sinuses
Published in British Journal of Neurosurgery, 2021
Safiye Çavdar, Bilgehan Solmaz, Özgül Taniş, Orhan Ulas Guler, Hakkı Dalçık, Evren Aydoğmuş, Leyla Altunkaya, Erdoğan Kara, Hızır Aslıyüksek
Brain herniation is a highly mortal complication of space-occupying lesions of the brain (intracranial hemorrhages, tumors, hydrocephalus or any lesion leads to brain edema) and it is related to the compensation capacity of the dural reflections of falx and tentorium cerebelli.6 The dimensions and increased number of folds may contribute to the elasticity of falx cerebelli which may affect the compensation capacity. Early intervention may be considered in posterior fossa tumors or hemorrhages in patients with multiple falx cerebelli. Therefore, being aware of the variations related to dural folds and occipital sinus can be important for neurosurgeons and neuroradiologists as these aberrant structures could cause haemorrhage during suboccipital approaches or may lead to erroneous interpretation during imaging of the posterior cranial fossa.