Anatomy of the cranial meninges and dural venous sinuses

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Anatomy of the cranial meninges and dural venous sinuses

USMLE® Step 1 questions

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Anatomy of the cranial meninges and dural venous sinuses

Figure 1: Coronal section through the superior sagittal sinus showing the cranial meninges.
Figure 2: Dural infoldings. A. Anterolateral view. B. Superior view (calvaria removed).
Figure 3. Posterolateral view of the dural venous sinuses. 
Figure 4: Emissary veins and granular foveolae. A. Posterolateral view showing dural venous sinuses. B. Coronal section of superior sagittal sinus showing emissary vein. C. Inferior view of calvaria showing granular foveolae caused by enlarged arachnoid granulations.
Figure 5: Posterior view of coronal section of cavernous sinuses. 
Figure 6: Blood supply to the dura mater: middle meningeal artery.
Figure 7: Innervation of the dura mater. 


USMLE® Step 1 style questions USMLE

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A 37-year-old man presents to the emergency department for evaluation of excruciating headaches. The headaches began three days ago and have progressively worsened. Temperature is 37.9°C (100.2°F), blood pressure is 152/90 mmHg, and pulse is 97/min. On physical examination, the headache is worsened with the Valsalva maneuver. No signs of trauma are present over the skull. CT imaging is obtained and reveals thrombosis within the portion of the superior sagittal sinus overlying the occipital lobe. The affected area of the dural venous system is primarily innervated by which of the following nerves?  


The brain and spinal cord are covered by the meninges, which are three layers or membranes of connective tissue that not only protect the brain and spinal cord, but also form a framework for vessels and venous sinuses.

Just think of this as the brain needing three layers of blankets when going to bed at night to make sure it is extra cozy and secure! These three layers, from superficial to deep, are the dura mater, arachnoid mater, and pia mater.

The dura mater is a tough, thick, fibrous external meningeal layer. Deep to the dura mater is the arachnoid mater. The dura and arachnoid mater are separated from each other by a potential space called the subdural space.

Deep to the arachnoid mater is the pia mater. The pia mater is a delicate vascular layer that is intimately adhered to the brain, covering the gyri and extending along the different sulci and fissures.

Together, the arachnoid and pia mater are collectively known as the leptomeninges. Between the arachnoid mater and the pia mater is the subarachnoid space, also known as the leptomeningeal space, which is a true space between the arachnoid and pia mater which contains cerebrospinal fluid or CSF for short, as well as major vessels and cranial nerves.


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