Neurology

Question 1

Where is most CSF produced

Answer 1

the choroid plexus in the lateral, third and fourth ventricles

Question 2

What is the toal CSF volume in a neonate

Answer 2

60mls (adult 150)

Question 3

What is CSF production

Answer 3

500mls per day

Question 4

What is CSF production

Answer 4

500mls per day

Question 5

What colour is CSF

Answer 5

clear

Question 6

What colour might it be if there is blood in in

Answer 6

yellow pink or straw coloured

Question 7

What would turbid or cloudy CSF indicate

Answer 7

inflammatory cells

the presence of micro organism or raised protein

Question 8

What would turbid or cloudy CSF indicate

Answer 8

inflammatory cells

the presence of micro organism or raised protein

Question 9

What should CSF glucose be

Answer 9

2/3rds that of blood glucose

a ration of CSF to blood clucose is considered pathological

Question 10

What WBC and RBC levels are in normal CSF

Answer 10

no RBC
less the 5 WBC per ml
less than 2g protein per mil

Question 11

What vertebral level does the spinal cord terminate

Answer 11

L1

Question 12

What are the indication for a lumbar puncture

Answer 12

CNS infection
Subarachnoid haemorrhage
Therapeutic reduction of CSF
Sampling CSF

Question 13

What are the contraindications

Answer 13

Raised ICP (!!!!)
Spinal cord mass or lesion
Pailloedema
Incontrolled bleeding diathesis
Spinal column deformity
lack fo patient cooperation
local skin infection at puncture site

Question 14

What are the contraindications

Answer 14

Raised ICP (!!!!)
Spinal cord mass or lesion
Pailloedema
Incontrolled bleeding diathesis
Spinal column deformity
lack fo patient cooperation
local skin infection at puncture site

Question 15

What happens in a younger child when intracranial pressure is raised

Answer 15

their head size will expand

fontanelles not fused yet

Question 16

What happens in a younger child when intracranial pressure is raised

Answer 16

their head size will expand

fontanelles not fused yet

Question 17

What is CPP

Answer 17

cerebral perfusion pressure =

mean arterial blood pressure-intracranial pressure

Question 18

What is CPP

Answer 18

cerebral perfusion pressure =

mean arterial blood pressure-intracranial pressure

Question 19

What is hydrocephalus

Answer 19

a disturbance in CSF production flow and reabsorption resulting in an excessive amount of CSF in skull

Question 20

What is the most important sign of hydrocephalus in an infant

Answer 20

enlarged head circumferance

Question 21

What is the most important sign of hydrocephalus in an infant

Answer 21

enlarged head circumferance

Question 22

What are late signs of hydrocephalus

Answer 22

splaying sutures
enlarged fontanelles
setting sun sign
prominent scalp veins
poor feeding
vominting
reduced activity
irritable

Question 23

What are late signs of hydrocephalus

Answer 23

splaying sutures
enlarged fontanelles
setting sun sign
prominent scalp veins
poor feeding
vominting
reduced activity
irritable

Question 24

What are the signs and symptoms in older childen and adults of hydrocephalus

Answer 24

Slowing of mental capacity, cognitive deterioration
Headaches (initially in the morning)
Neck pain, suggesting tonsillar herniation
Vomiting, more significant in the morning
Blurred vision: A consequence of papilledema and, later, of optic atrophy
Double vision: Related to unilateral or bilateral sixth nerve palsy
Difficulty in walking secondary to spasticity: Preferentially affects the lower limbs because the periventricular pyramidal tract is stretched by the hydrocephalus
Drowsiness

Question 25

How is hydrocephalus investigated

Answer 25

Imaging - ultrasounf, CT, MRI

Question 26

What else can obstucte the flow of CSF

Answer 26

aqueductal stenosis

Arnold chiari malformation

Question 27

How can you drain excessive csf

Answer 27

ventriculoperitoneal shunt